Long-term outcome after allogeneic hematopoietic stem cell transplantationfor advanced stage acute myeloblastic leukemia: a retrospective study of 379 patients reported to the Societe Francaise de Greffe de Moelle (SFGM)

To assess the place of allogeneic hematopoietic stem cell transplantation ( HSCT) in the advanced stage of acute myeloid leukemia (AML), we retrospecti vely analyzed 379 consecutive patients who underwent allogeneic HSCT for ad vanced AML. The median follow-up of the entire cohort was 7.5 years. Sixty- nine patients (18%) were transplanted with primary resistant disease. Three hundred and ten (82%) were relapsed patients, 94 (30%) of whom were in unt reated relapse, 67 (22%) in refractory relapse and 149 (48%) in 2nd or 3rd complete remission at time of transplantation. The 5-year probabilities of overall survival (OS), disease-free survival (DFS), and transplant-related mortality (TRM) were 22 +/- 4% 20 +/- 4%, 45 +/- 6%, respectively. In multi variate analysis, we demonstrated the favorable impact on OS, DFS and TRM o f two factors over which we have no control (age <15 years, complete remiss ion achievement) and three factors over which we have some control (female donor, acute and chronic graft-versus-host disease). The results of this st udy suggest that the graft-versus-leukemia effect is important in advanced AML and that new HSCT modalities are needed for some patients with this ind ication.