Allogeneic hematopoietic stem cell transplantation improves long-term outcome for relapsed AML patients across all ages: results from two East German Study Group Hematology and Oncology (OSHO) trials

Abstract

SummaryRelapse of acute leukemia is a frequent complication with uncertain outcome and poorly defined risk factors. From 1621 patients entered into two prospective clinical trials (AML02; n = 740 and AML04; n = 881), 74.2% reached complete remission (CR) 1 after induction(s) and 59 patients after additional induction ± hematopoietic cell transplantation (HCT). Of the non-refractory patients, 48.4% with a median age of 63 (range 17–85) years relapsed. Relapses occurred within 6 months after CR in 46.5%, between 7 and 18 months in 38.7%, and after 18 months in 14.8% of patients. Relapse treatment resulted in CR2 in 39% of patients depending upon age (54.5% of ≤ 60 and 28.6% of > 60 years), duration of CR1, and treatment of relapse. Overall survival (OS) was 10.9 (7.4–16.2) %, but OS after HCT ± intensive chemotherapy (ICT) was 39.3% (31.8–48.6) at 5 years and not different in younger and older patients. Donor lymphocyte infusion ± chemotherapy and ICT alone resulted only in OS of 15.4% and of 5%, respectively. Independent favorable factors for OS were long CR1 duration, and HCT, while non-monosomal disease was beneficial for OS in elderly patients. Leukemia-free survival [LFS; 24.9 (19.5–31.7) % at 10 years] was affected by similar risk factors. In a competing risk model, the relapse incidence at 5 years was 53.5 ± 3.5% and the non-relapse mortality rate 21.7 ± 2.9%. Lower relapse incidence was observed in patents with HCT, long CR1 duration, and female gender. Risk factors for non-relapse mortality were HCT in younger and type of AML in elderly patients. In conclusion, allogeneic HCT ± IC improved the results in relapsed AML in younger and elderly patients. Increasing CR2 rates and HCT frequency will be the challenge for the next years. Relapse of the disease remains the major problem.

Azacitidine-induced reconstitution of the bone marrow T cell repertoire is associated with superior survival in AML patients

“…Acute myeloid leukemia (AML) remains a fatal disease with only around 10–15% long-term survival in patients older than 60 years [ 1 , 2 ]. For eligible patients, the standard treatment is based on intensive chemotherapy and has hardly changed throughout the last decades.…”

Continuous and differential improvement in worldwide access to hematopoietic cell transplantation: activity has doubled in a decade with a notable increase in unrelated and non-identical related donors

“…(10) Survival outcomes for allogeneic HCT in acute leukemia continue to improve, as studies primarily in leukemia have shown improvement in survival outcomes, with notable decreases in non-relapse mortality over time. (3)(4)(5)20, 21) Thus, allogeneic HCT has become the standard of care in many patients with leukemia especially in diseases with high relapse risk including older patients (22,23) Allogeneic HCT for nonmalignant disease, including hereditary disease in pediatric patients, showed a more than two-fold increase in this decade.…”

Consensus-Based Guidelines for Acute Myeloid Leukemia Management in Gulf Cooperation Council Countries: Addressing Unmet Regional Needs and the Changing AML Landscape

“…The Delphi process facilitated broad consensus by involving all panel members in round 2, promoting honest opinions through anonymous surveys and allowing members to justify disagreements through discussions. Despite the process's efficiency, time-saving benefits, and potential for reducing biases, 27 the study identified seven statements requiring clarification because of receiving no votes. While the Delphi technique complements other methods, it may not capture diverse perspectives on AML topics.…”