Predictive Value Of Karyotype On Outcome Of Autotransplants For Acute Myeloid Leukemia In Second Remission

The impact of karyotype on the outcome of patients who undergo autotransplant for acute myeloid leukemia (AML) in second remission (CR2) has not been explored. We evaluated the outcomes of 40 patients who proceeded to autotransplant for AML in CR2 at 2 centers. The median age at autotransplant was 50 years ( 18 - 64 years) and the median duration of first remission was 15 months (0.8 - 51 months). High-dose therapy was melphalan 140 - 160 mg/m(2) plus etoposide 60 mg/kg with or without total body irradiation ( 22), a busulfan-based regimen ( 17), and cyclophosphamide alone ( 1). Six patients (15%) died of treatment-related causes within the first 100 days. Event-free and overall survival at 3 years were both 38% (95% confidence interval 23 - 53%). At a median follow-up of 76 months ( 2 - 170) in surviving patients, 13 (32.5%) are alive and disease free. Graft purging did not significantly influence survival outcome (P = 0.94), although platelet engraftment was significantly delayed ( P = 0.02). The relative risk of an event ( relapse or death) for the karyotype risk groups was favorable 1.0; intermediate 4.2 ( 1.2 - 14.7); adverse 9.9 (1.5 - 63.9); unknown 2.3 (0.6 - 8.8) ( P = 0.028). We conclude that patients with AML in CR2 who undergo autotransplant can have durable remissions and those with a good risk karyotype are the most likely to obtain long-term disease-free survival.