165: Central Nervous System (CNS) Involvement at Diagnosis does not Adversely Affect the Outcome of High-Dose Chemotherapy and Transplant for Patients with Acute Myeloid Leukemia (AML)

Objective: To evaluate the impact of the presence of CNS disease at diagnosis in the outcome of AML patients who underwent high-dose chemotherapy and stem cell transplant. Methods: We performed a retrospective study of all transplants performed for AML in our institution between 1993 and 2007. Twenty-one patients (11 males) with CNS disease were identified. Five had unclassified AML, 2 M1, 2 M2, 9 M4 and 3 MDS. All but one patient had intermediate or poor cytogenetics. Twelve patients were in remission (4 in CR1, 6 in CR2, 2 in greater CR) at the time of transplant. Four patients had refractory relapse, 4 untreated relapse and one primary induction failure. All patients were in CNS CR at the time of transplant. Median age was 22.5 years (range 2–66). Three patients received autologous graft. The conditioning regimen was chemotherapy-based in 19 patients [Busulfan (Bu)-Fludarabine (Flu): 6; Bu-Cyclophosphamide (Cy)-Thiotepa (TEP): 6; Flu-Melphalan (Mel)-TEP: 2; Flu-Mel: 1; Flu-Mel-Mylotarg: 1; Bu-Cy: 1; Decitabine-Bu-Cy:1; Cy-Etoposide:1]. Two patients received Flu-Mel with TBI. GVHD prophylaxis was tacrolimus-based in 14/18 allogeneic transplants [with methotrexate (MTX) in 13 or steroids in one], cyclosporine-based in 2 (one with MTX, one with steroids) with 2 patients receiving T-cell depleted graft. The donor was matched related in 9, matched unrelated in 4, mismatched related in 4 and mismatched unrelated (cord) in 1. Eleven patients received marrow, 9 PBSC and one cord blood transplant. Patients received intrathecal chemotherapy monthly × 6 months post-transplant as CNS prophylaxis. Results: Twelve patients died (hemorrhage: 1, sepsis: 2, acute GVHD: 2, MOF:1, chronic GVHD:1, relapse: 5). With a median follow-up of 7.5 years, 9 patients are alive, 8 in CCR, one in CR after CNS relapse and salvage chemotherapy. Conclusions: The presence of CNS disease at diagnosis should not preclude the use of stem cell transplantation as treatment for AML.