Risk classification at diagnosis predicts post-HCT outcomes in intermediate-, adverse-risk, and KMT2A-rearranged AML.

Abstract

Little is known about whether risk classification at diagnosis predicts post-hematopoietic cell transplantation (HCT) outcomes in patients with acute myeloid leukemia (AML). We evaluated 8709 patients with AML from the CIBMTR database, and after selection and manual curation of the cytogenetics data, 3779 patients in first complete remission were included in the final analysis: 2384 with intermediate-risk, 969 with adverse-risk, and 426 with KMT2A-rearranged disease. An adjusted multivariable analysis detected an increased risk of relapse for patients with KMT2A-rearranged or adverse-risk AML as compared to those with intermediate-risk disease (hazards ratio [HR], 1.27; P = .01; HR, 1.71; P < .001, respectively). Leukemia-free survival was similar for patients with KMT2A rearrangement or adverse risk (HR, 1.26; P = .002, and HR, 1.47; P < .001), as was overall survival (HR, 1.32; P < .001, and HR, 1.45; P < .001). No differences in outcome were detected when patients were stratified by KMT2A fusion partner. This study is the largest conducted to date on post-HCT outcomes in AML, with manually curated cytogenetics used for risk stratification. Our work demonstrates that risk classification at diagnosis remains predictive of post-HCT outcomes in AML. It also highlights the critical need to develop novel treatment strategies for patients with KMT2A-rearranged and adverse-risk disease.

• Authors: Kamal Menghrajani, Alexandra Gomez-Arteaga, Rafael Madero-Marroquin, Mei-Jie Zhang, Khalid Bo-Subait, Jonathan Sanchez, Hai-Lin Wang, Mahmoud Aljurf, Amer Assal, Vera Ulrike Bacher, Sherif M Badawy, Nelli Bejanyan, Vijaya Raj Bhatt, Christopher Bredeson, Michael Byrne, Paul Castillo, Jan Cerny, Saurabh Chhabra, Stefan Octavian Ciurea, Zachariah DeFilipp, Nosha Farhadfar, Shahinaz Gadalla, Robert Peter Gale, Siddhartha Ganguly, Lohith Gowda, Michael R Grunwald, Shahrukh Hashmi, Gerhard Hildebrandt, Christopher G Kanakry, Ankit Kansagra, Farhad Khimani, Maxwell Krem, Hillard Lazarus, Hongtao Liu, Rodrigo Martino, Fotios V Michelis, Sunita Nathan, Taiga Nishihori, Richard Olsson, Ran Reshef, David Rizzieri, Jacob M Rowe, Bipin N Savani, Sachiko Seo, Akshay Sharma, Melhem Solh, Celalettin Ustun, Leo F Verdonck, Christopher Hourigan, Brenda Sandmaier, Mark Litzow, Partow Kebriaei, Daniel Weisdorf, Yanming Zhang, Martin S Tallman, Wael Saber
• Journal: Blood advances (Blood Adv) Vol. 6 Issue 3 Pg. 828-847 (01 08 2022) ISSN: 2473-9537 [Electronic] United States
• PMID: 34551064 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Topics

• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia, Myeloid, Acute (diagnosis, genetics, therapy)
• Recurrence
• Remission Induction