Personalized prediction of overall survival in patients with AML in non-complete remission undergoing allo-HCT.
Shigeki HirabayashiRyuji UozumiTadakazu KondoYasuyuki AraiTakahito KawataNaoyuki UchidaAtsushi MarumoKazuhiro IkegameTakahiro FukudaTetsuya EtoMasatsugu TanakaAtsushi WakeJunya KandaTakafumi KimuraKen TabuchiTatsuo IchinoheYoshiko AtsutaMasamitsu YanadaShingo YanoPublished in: Cancer medicine (2021)
Allogenic hematopoietic stem cell transplantation (allo-HCT) is the standard treatment for acute myeloid leukemia (AML) in non-complete remission (non-CR); however, the prognosis is inconsistent. This study aimed to develop and validate nomograms and a web application to predict the overall survival (OS) of patients with non-CR AML undergoing allo-HCT (cord blood transplantation [CBT], bone marrow transplantation [BMT], and peripheral blood stem cell transplantation [PBSCT]). Data from 3052 patients were analyzed to construct and validate the prognostic models. The common significant prognostic factors among patients undergoing allo-HCT were age, performance status, percentage of peripheral blasts, cytogenetic risk, chemotherapy response, and number of transplantations. The conditioning regimen was a significant prognostic factor only in patients undergoing CBT. Compared with cyclophosphamide/total body irradiation, a conditioning regimen of ≥3 drugs, including fludarabine, with CBT exhibited the lowest hazard ratio for mortality (0.384; 95% CI, 0.266-0.554; p < 0.0001). A conditioning regimen of ≥3 drugs with CBT also showed the best leukemia-free survival among all conditioning regimens. Based on the results of the multivariable analysis, we developed prognostic models showing adequate calibration and discrimination (the c-indices for CBT, BMT, and PBSCT were 0.648, 0.600, and 0.658, respectively). Our prognostic models can help in assessing individual risks and designing future clinical studies. Furthermore, our study indicates the effectiveness of multi-drug conditioning regimens in patients undergoing CBT.
Keyphrases
- prognostic factors
- acute myeloid leukemia
- patients undergoing
- free survival
- stem cell transplantation
- bone marrow
- cord blood
- allogeneic hematopoietic stem cell transplantation
- high dose
- peripheral blood
- randomized controlled trial
- cell cycle arrest
- low dose
- newly diagnosed
- emergency department
- systematic review
- stem cells
- cardiovascular events
- squamous cell carcinoma
- disease activity
- ejection fraction
- combination therapy
- type diabetes
- radiation therapy
- cardiovascular disease
- big data
- adverse drug
- artificial intelligence
- cell therapy
- deep learning
- coronary artery disease
- patient reported