Early blast clearance during sequential conditioning prior to allogeneic stem cell transplantation in patients with acute myeloid leukaemia.
Julian RonnackerMarc-Andre UrbahnChristian ReichertsLina KollochPhilipp BerningSarah SandmannEva EßelingSimon CallMatthias FloethJulia MarxJörn AlbringJan-Henrik MikeschChristoph SchliemannGeorg LenzMatthias StelljesPublished in: British journal of haematology (2024)
For patients with relapsed or refractory AML, sequential conditioning prior to allogeneic stem cell transplantation (alloSCT) is an established and potentially curative treatment option. Early response to treatment during conditioning indicates chemotherapy-responsive disease and may have prognostic value. We retrospectively evaluated blast clearance on day 5 after melphalan, administered 11 days prior to alloSCT as part of a sequential conditioning in 176 patients with active AML. Overall survival (OS) was 52% (95% confidence interval [CI] 45%-60%), and relapse-free survival (RFS) was 47% (95% CI 40%-55%) at 3 years. Patients who achieved early blast clearance did not show a significant improvement in OS and RFS (OS, hazard ratio [HR] HR 0.75, p 0.19; RFS, HR 0.71, p 0.09, respectively), but had a significantly lower non-relapse mortality rate (HR 0.46, p 0.017). HLA-mismatched donor, older age, adverse genetic risk and higher comorbidity scores were associated with inferior survival outcomes. A high initial blast count was only associated with inferior prognosis in patients receiving chemotherapy-only compared to total body irradiation containing conditioning therapy. These results indicate that for patients transplanted with active AML, sensitivity to chemotherapy might be of less importance, compared to other disease- and transplant-related factors.
Keyphrases
- stem cell transplantation
- high dose
- free survival
- acute myeloid leukemia
- locally advanced
- low dose
- end stage renal disease
- allogeneic hematopoietic stem cell transplantation
- newly diagnosed
- prognostic factors
- bone marrow
- squamous cell carcinoma
- physical activity
- dendritic cells
- chronic kidney disease
- radiation therapy
- peritoneal dialysis
- genome wide
- gene expression
- stem cells
- coronary artery disease
- dna methylation
- mesenchymal stem cells
- peripheral blood
- copy number
- combination therapy
- chemotherapy induced
- drug delivery
- immune response
- patient reported outcomes
- electronic health record
- replacement therapy