Factors associated with risk of central nervous system relapse in patients with non-core binding factor acute myeloid leukemia.
Elias J JabbourNaval Guastad DaverNicholas James ShortXuelin HuangHsiang-Chun ChenAbhishek MaitiFarhad RavandiJorge CortesSimon Abi AadGuillermo Garcia-ManeroZeev EstrovTapan KadiaSusan O'BrienBouthaina DabajaCarlos Bueso-RamosPaolo StratiCarol BivinsSherry PierceHagop M KantarjianPublished in: American journal of hematology (2017)
Central nervous system (CNS) relapse is uncommon in patients with acute myeloid leukemia (AML) with the use of high-dose cytarabine containing chemotherapy regimens. The clinical and molecular features associated with a higher risk of CNS relapse are not well defined. We assessed the incidence and outcome of CNS relapses among 1245 patients with relapsed/refractory AML referred to our institution between 2000 and 2014. CNS leukemia relapse was observed in 51 patients (4.1%). Using a multivariate regression model and after adjusting for age, FLT3-ITD mutation (OR = 2.33; P = .02) and elevated LDH (>1000 IU/L, OR = 1.99; P = .04) were independent predictive factors for CNS relapse. Patients under 64 years of age with 0, 1, or 2 baseline adverse features had a probability of 3.8%, 7.0%-8.0%, and 13.9% for developing CNS disease, respectively. Our study identifies patients with AML at higher risk for CNS relapse in whom prophylactic CNS therapy may be warranted.
Keyphrases
- acute myeloid leukemia
- blood brain barrier
- allogeneic hematopoietic stem cell transplantation
- end stage renal disease
- free survival
- high dose
- chronic kidney disease
- ejection fraction
- peritoneal dialysis
- stem cells
- prognostic factors
- low dose
- squamous cell carcinoma
- risk factors
- acute lymphoblastic leukemia
- mesenchymal stem cells
- diffuse large b cell lymphoma
- locally advanced
- patient reported