Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation.
Mary-Elizabeth M PercivalHai-Lin WangMei-Jie ZhangWael SaberMarcos J deLimaMark LitzowPartow KebriaeiHisham Abdel-AzimKehinde AdekolaMahmoud AljurfUlrike BacherSherif M BadawyAmer BeitinjanehNelli BejanyanVijaya Raj BhattMichael ByrneJean-Yves CahnPaul CastilloNelson ChaoSaurabh ChhabraEdward CopelanCorey CutlerZachariah DeFilippAjoy DiasMiguel Angel DiazElihu EsteyNosha FarhadfarHaydar A FrangoulCésar O FreytesRobert Peter GaleSiddhartha GangulyLohith GowdaMichael Richard GrunwaldNasheed M HossainRammurti T KambleChristopher G KanakryAnkit KansagraMohamed A Kharfan-DabajaMaxwell KremHillard M LazarusJong Wook LeeJane L LiesveldRichard J LinHongtao LiuJoseph P McGuirkReinhold MunkerHemant S MurthySunita NathanTaiga NishihoriRichard F OlssonNeil PalmisianoJakob R PasswegTim PrestidgeOlle RingdénDavid A RizzieriWitold B RybkaMary Lynn SavoieKirk R SchultzSachiko SeoAkshay SharmaMelham M SolhRoger StrairMarjolein van der PoelLeo F VerdonckJean A YaredDaniel J WeisdorfBrenda M SandmaierPublished in: Bone marrow transplantation (2021)
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.
Keyphrases
- end stage renal disease
- acute myeloid leukemia
- ejection fraction
- newly diagnosed
- chronic kidney disease
- free survival
- peritoneal dialysis
- stem cell transplantation
- cardiovascular events
- rheumatoid arthritis
- patient reported outcomes
- coronary artery disease
- disease activity
- high dose
- skeletal muscle
- optical coherence tomography
- cell therapy
- patient reported
- ulcerative colitis