Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kremser, S.
Outcome of patients with acute myeloid leukaemia after allogeneic haematopoietic stem cell transplantation
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2015. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Wölfler Albert
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- Abstract:
- Introduction: Allogeneic HSCT is the most effective treatment for curing patients with AML. Accordingly, consensus exists across current guidelines to recommend allogeneic HSCT for eligible patients with intermediate- or high-risk AML in first complete remission as well as for all patients with AML relapse. However, despite advances in transplantation medicine as well as supportive care during the last two decades, relapse- and treatment-related mortality of patients with AML undergoing allogeneic HSCT remains a major concern negatively affecting long-term outcome. Methods: We performed a retrospective analysis of AML patients treated with allogeneic HSCT at the Division of Haematology, Medical University of Graz to determine overall survival and to identify (novel) risk factors for adverse outcome. Descriptive statistical methods as well as Kaplan Meier estimates and Cox regression models were used for analyzing the collected data. Results: In total, 204 patients (108 males and 96 females) were included in the study. After a median follow up of 35 months, median survival was 27 months with an estimated overall survival (OS) at 5 years of 45%. We observed similar 5-year OS across matched donor types (matched related donor, MRD: 56% and matched unrelated donor, MUD: 53%), but significant inferior survival for patients receiving mismatched umbilical cord blood (21%) or an allograft from a mismatched donor (25%). With an overall incidence of 29% at 5 years, relapse was the main cause of death in this cohort. In multivariate analysis, remission status at time of transplantation (not in first complete remission, p<0,001), hyperglycemia during the engraftment period (p=0,003) and HLA-mismatch (p=0,045) were identified as independent negative risk factors for OS. Conclusion: Relevant survival parameters as well as risk factors for adverse outcome observed in our retrospective study compare well with published studies. In addition, we identified hyperglycemia during the engraftment period as a major risk factor for OS after HSCT in AML patients. Prospective clinical trials are therefore warranted to validate this newly discovered risk factor but also to evaluate the impact of strict blood glucose management on outcome of AML patients undergoing HSCT.