Secondary AML (sAML) has a poor prognosis with conventional chemotherapy alone. Allogeneic hematopoietic cell transplantation (HCT) is beneficial for high-risk AML. Data comparing outcomes of transplants for patients with de novo and sAML are limited. We compared outcomes of patients transplanted for de novo and sAML in first complete remission and investigated the effect of age, HCT comorbidity index (HCT-CI) and karyotype in both groups. A total of 264 patients with de novo (n = 180) and sAML (n = 84) underwent allogeneic HCT between 1999 and 2013. Median age at transplant was 51 years (range 18-71), median follow-up of survivors was 77 months. Evaluation of all patients demonstrated no significant difference between de novo and sAML for overall survival (P = 0.18), leukemia-free survival (P = 0.17), cumulative incidence of relapse (P = 0.51) and non-relapse mortality (P = 0.42). Multivariable and propensity score analyses confirmed the comparable outcomes between de novo and sAML post transplant. Although sAML demonstrates outcomes inferior to de novo AML treated with chemotherapy alone, outcomes following allogeneic HCT are comparable between the two groups.

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For AML, older age, advanced disease and increased hematopoietic cell transplant comorbidity index (HCT-CI) are associated with worse prognosis following allogeneic hematopoietic cell transplantation (HCT). This single-center retrospective study investigated the influence of pre-transplant characteristics on outcomes of 387 patients undergoing allogeneic HCT for AML in CR1 and CR2. The multivariable analysis model for overall survival (OS) included age (hazard ratio (HR) = 2.24 for ages 31-64 years and HR = 3.23 for age ⩾ 65 years compared with age ⩽ 30 years, P = 0.003), remission status (HR = 1.49 for CR2 compared with CR1, P = 0.005) and HCT-CI score (HR = 1.47 for ⩾ 3 compared with o 3, P = 0.005). Transplant year was significantly associated with OS (P = 0.001) but this did not influence the model. A weighted score was developed with age ⩽ 30, CR1 and HCT-CI score o 3 receiving 0 points each, and CR2 and HCT-CI score ⩾ 3 receiving 1 point each. Ages 31-64 received 2 points, age ⩾ 65 received 3 points. Scores were grouped as follows: scores 0-1 (low risk, n = 36), score 2 (intermediate-low risk, n = 147), score 3 (intermediate-high risk, n = 141) and scores 4-5 (high risk, n = 63) with 3-year OS of 71%, 55%, 42% and 29% for scores 0-1, 2, 3 and 4-5, respectively (P o 0.0001). The score predicted nonrelapse mortality (P = 0.03) but not cumulative incidence of relapse (P = 0.18). This model should be validated for the pre-HCT assessment of AML patients in CR1 and CR2.