AML Transplant Outcomes
For some people with acute myelogenous leukemia (AML), a bone marrow or cord blood transplant (also called a BMT) may offer the best chance for a long-term remission from their disease. This page provides data on some patients' outcomes after a transplant to treat AML. For a more complete overview of AML and how it may be treated, see Acute Myelogenous Leukemia (AML).
It is a good idea to ask your doctor for help interpreting these data and any other survival outcomes data you find. Your doctor can provide context for these data and discuss your specific situation with you. For more things to consider, see Understanding Survival Outcomes Data.
Transplant outcomes
Figures 1 and 2 below show results of autologous transplants (or autotransplants), which use the patient's own blood-forming cells. Figures 3-8 below show results of allogeneic transplants, which use blood-forming cells from a family member or unrelated donor or cord blood unit.
For allogeneic transplants using adult donors, the blood-forming cells can be collected from the donor’s marrow or from the bloodstream (peripheral blood stem cells, or PBSC). The figures below showing data from the National Marrow Donor Program (NMDP) state whether patients received marrow or PBSC.
Though the outcomes for marrow and PBSC transplants may appear different below, there could be many reasons for this. For example, the patient groups may not have the same risk factors (such as age or past treatments). Doctors are still trying to find out whether one works better than the other. A large clinical trial comparing marrow and PBSC is now in progress.
Figure 1.
Probability of Survival after Autotransplants for AML, Age < 20 Years, 1998-2004 - by disease status. (CIBMTR data)
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Figure 2.
Probability of Survival after Autotransplants for AML, Age > 20 Years, 1998-2004 - by disease status. (CIBMTR data)
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Figure 3.
Probability of Survival after HLA-Identical Sibling Donor Tranpslants for AML with Myeloablative Conditioning, 1998-2004 — by disease status. (CIBMTR data)
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Figure 4.
Acute Myelogenous Leukemia: Survival of adult (age > 18 years) marrow recipients with myeloablative preparative regimens, by disease stage, unrelated donor transplants facilitated by the NMDP, 1998 - 2006. (NMDP data)
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Figure 5.
Acute Myelogenous Leukemia: Survival of adult (age > 18 years) PBSC recipients with myeloablative preparative regimens, by disease stage, unrelated donor transplants facilitated by the NMDP, 1998 - 2006. (NMDP data)
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Figure 6.
Acute Myelogenous Leukemia: Survival of pediatric marrow recipients with myeloablative preparative regimens, by disease stage, unrelated donor transplants facilitated by the NMDP, 1998 - 2006. (NMDP data)
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Figure 7.
Acute Myelogenous Leukemia: Survival of older adult adult (age > 55) marrow and PBSC recipients with non-myeloablative preparative regimens, unrelated donor transplants facilitated by the NMDP, 1998-2006. (NMDP data)
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Figure 8.
Acute Myelogenous Leukemia: Survival of older adult (age > 55) marrow and PBSC recipients with myeloablative preparative regimens, unrelated donor transplants facilitated by the NMDP, 1998-2006. (NMDP data)
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Affect of disease status on transplant outcomes The status of the disease at the time of transplant can make a difference in a patient's likelihood of survival. The figures above show higher long-term survival rates for patients who received a transplant in early disease compared to advanced disease for:
- Allogeneic transplants using matched sibling donors (Figure 3)
- Autologous transplants (Figures 1 and 2)
However, the results were different for patients who received transplants from unrelated donors:
- For adults who received transplants from unrelated donors, outcomes were similar for patients who received transplants during first remission and second remission, but significantly lower for patients with advanced disease (Figure 4-8).
- For children who received transplants from unrelated donors, outcomes were higher for transplants in second remission compared to first remission (Figure 6).
One reason for this difference is the risk factors of the patients who received unrelated donor transplants through the NMDP. More patients who received unrelated donor transplants at first remission had high-risk cytogenetics (changes in the chromosomes of leukemia cells). These patients started out with a higher risk that their disease would not respond to treatment than patients who received transplants at second remission. For patients with high-risk disease, an allogeneic transplant (with a suitable donor, related or unrelated) in first remission offers the best chance for a long-term remission.
Affect of donor on transplant outcomes For allogeneic transplants, a closely matched donor improves the chances of a successful transplant. In general, transplants using a matched sibling have had the best results. However, outcomes for transplants using unrelated donors continue to improve. For some groups of patients, outcomes for sibling donor and unrelated donor transplants are similar.
Affect of age on transplant outcomes Children generally have a better chance than adults of a good outcome from transplant (Figures 1, 2, and 4-8). Adults age 60 or older are more likely than younger adults to have high-risk disease factors. Older adults are less likely to respond well to treatment and may be less able to tolerate the intense treatment of a standard transplant. A transplant using less intense treatment may be an option for some of these patients. This type of transplant is called a reduced-intensity transplant or non-myeloablative transplant. Figure 7 shows outcomes for older adults who received non-myeloablative transplants. Figure 8 shows outcomes for older adults who received standard, myeloablative transplants.
Information to share with your doctor The Physician Resources section of this Web site includes information for doctors about timing and outcomes of transplants for AML, as well as references to related medical journal articles. You may want to share some of this information with your doctor.
Contributing editorsC. F. LeMaistre, M.D., Southwest Texas Methodist Hospital, San Antonio, Texas
Anthony S. Stein, M.D., City of Hope National Medical Center, Duarte, Calif.
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