Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation.

Abstract

Acute myeloid leukemia (AML) patients often undergo allogeneic hematopoietic cell transplantation (alloHCT) in first complete remission (CR). We examined the effect of depth of clinical response, including incomplete count recovery (CRi) and/or measurable residual disease (MRD), in patients from the Center for International Blood and Marrow Transplantation Research (CIBMTR) registry. We identified 2492 adult patients (1799 CR and 693 CRi) who underwent alloHCT between January 1, 2007 and December 31, 2015. The primary outcome was overall survival (OS). Multivariable analysis was performed to adjust for patient-, disease-, and transplant-related factors. Baseline characteristics were similar. Patients in CRi compared to those in CR had an increased likelihood of death (HR: 1.27; 95% confidence interval: 1.13-1.43). Compared to CR, CRi was significantly associated with increased non-relapse mortality (NRM), shorter disease-free survival (DFS), and a trend toward increased relapse. Detectable MRD was associated with shorter OS, shorter DFS, higher NRM, and increased relapse compared to absence of MRD. The deleterious effects of CRi and MRD were independent. In this large CIBMTR cohort, survival outcomes differ among AML patients based on depth of CR and presence of MRD at the time of alloHCT. Further studies should focus on optimizing post-alloHCT outcomes for patients with responses less than CR.

• Authors: Mary-Elizabeth Percival, Hai-Lin Wang, Mei-Jie Zhang, Wael Saber, Marcos de Lima, Mark Litzow, Partow Kebriaei, Hisham Abdel-Azim, Kehinde Adekola, Mahmoud Aljurf, Ulrike Bacher, Sherif M Badawy, Amer Beitinjaneh, Nelli Bejanyan, Vijaya Bhatt, Michael Byrne, Jean-Yves Cahn, Paul Castillo, Nelson Chao, Saurabh Chhabra, Edward Copelan, Corey Cutler, Zachariah DeFilipp, Ajoy Dias, Miguel Angel Diaz, Elihu Estey, Nosha Farhadfar, Haydar A Frangoul, César O Freytes, Robert Peter Gale, Siddhartha Ganguly, Lohith Gowda, Michael Grunwald, Nasheed Hossain, Rammurti T Kamble, Christopher G Kanakry, Ankit Kansagra, Mohamed A Kharfan-Dabaja, Maxwell Krem, Hillard M Lazarus, Jong Wook Lee, Jane L Liesveld, Richard Lin, Hongtao Liu, Joseph McGuirk, Reinhold Munker, Hemant S Murthy, Sunita Nathan, Taiga Nishihori, Richard F Olsson, Neil Palmisiano, Jakob R Passweg, Tim Prestidge, Olov Ringdén, David A Rizzieri, Witold B Rybka, Mary Lynn Savoie, Kirk R Schultz, Sachiko Seo, Akshay Sharma, Melhem Solh, Roger Strair, Marjolein van der Poel, Leo F Verdonck, Jean A Yared, Daniel Weisdorf, Brenda M Sandmaier
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 56 Issue 9 Pg. 2108-2117 (09 2021) ISSN: 1476-5365 [Electronic] England
• PMID: 33864019 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Nature Limited.

Topics

• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia, Myeloid, Acute (therapy)
• Neoplasm, Residual
• Prognosis
• Remission Induction
• Retrospective Studies