Allogeneic hematopoietic stem cell transplant overcomes poor prognosis of acute myeloid leukemia with myelodysplasia-related changes

Abstract

Recent studies have shown that acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) exhibits a worse clinical outcome than AML not otherwise specified (AML-NOS). However, transplant outcomes of patients with AML-MRC have not been reported compared to patients with AML-NOS. We analyzed transplant outcomes among 147 patients with AML-MRC or AML-NOS who underwent allogeneic hematopoietic stem cell transplant (allo-HSCT) in a single institution. There were no significant differences in the 2-year overall survival (OS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM) between the two groups (2-year OS: 48% vs. 59%; 2-year CIR: 37% vs. 35%; 2-year NRM: 19% vs. 13%). Subgroup analysis adjusting for age and disease status demonstrated the same results between the two groups. Furthermore, multivariate analysis showed that AML-MRC was not an independent prognostic factor for poor prognosis in the setting of allo-HSCT (p = 0.7). These results suggest that allo-HSCT may overcome the poor prognosis of AML-MRC.

Risk Stratification and Prognosticators of Acute Myeloid Leukemia with Myelodysplasia-Related Changes in Patients Undergoing Allogeneic Stem Cell Transplantation: A Retrospective Study of the Adult Acute Myeloid Leukemia Working Group of the Japan Society for Hematopoietic Cell Transplantation

“…Following the recommendations for allo-SCT in patients with AML with intermediate or poor cytogenetic risk [11,12], most fit patients with AML-MRC undergo allo-SCT. Because AML-MRC is a heterogeneous disease, transplantation outcomes in these patients can be highly variable; however, data on transplantation outcomes in patients with AML-MRC are sparse [13], and detailed transplantation outcomes in a largescale cohort fulfilling the WHO classification criteria for AML-MRC have not been reported. Therefore, the prognostic factors for patients with AML-MRC undergoing allo-SCT remain to be elucidated.…”

Successful Treatment of Behçet's Disease Associated with Acute Myeloid Leukemia with Myelodysplasia-related Changes Using Azacitidine and Tacrolimus before Allogeneic Hematopoietic Stem Cell Transplantation

“…Therefore, the patient received azacitidine as consolidation chemotherapy. Allogeneic HSCT is the only curative therapy for AML-MRC (15). Myeloablative conditioning regimens, especially those including total body irradiation, can cause serious mucosal injury (11).…”

AML with Myelodysplasia-Related Changes: Development, Challenges, and Treatment Advances

“…Two single-institution studies from Japan have demonstrated similar OS, non-relapse mortality (NRM), and cumulative incidence of relapse (CIR) between patients with and without MRC. In the first study by Ikegawa et al, out of 139 patients, 60 patients with MRC experienced similar 2-year OS, CIR, and NRM rates of 48%, 37%, and 19%, respectively, while patients without MRC experienced rates of 59%, 35%, and 13%, respectively [45]. AML-MRC was not an independent prognostic factor for poor outcomes after alloHSCT in multivariate analysis (p = 0.7).…”

“…AlloHSCT is advised for all patients with AML-MRC and remains the only known potentially curative therapy in this patient population [45]. Indeed, alloHSCT may be the "great equalizer" for patients with AML-MRC as alloHSCT has been shown to potentially offset the poor prognostic factors associated with the underlying aggressive disease biology.…”