Comparable outcomes post allogeneic hematopoietic cell transplant for patients with de novo or secondary acute myeloid leukemia in first remission

Abstract

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.

Extramedullary disease at diagnosis of AML does not influence outcome of patients undergoing allogeneic hematopoietic cell transplant in CR1

“…We also note that 105 patients (35% of the cohort) were originally diagnosed with secondary AML; however, this parameter did not influence post-transplant outcomes, and we have reported this previously. 21 The present study did not reflect on the general prevalence of EMD at the time of AML diagnosis. The percentage of EMD patients in our cohort was slightly higher (13%) than in the other allo-HCT cohorts previously reported.…”

“…This may be the result of a statistical effect due to the relatively small cohort size, keeping in mind that the distribution of cytogenetic risk between patients with and without EMD was similar. We also note that 105 patients (35% of the cohort) were originally diagnosed with secondary AML; however, this parameter did not influence post‐transplant outcomes, and we have reported this previously …”

Therapy-related myelodysplastic syndromes, or are they?

“…However, the OS in this cohort is significantly lower than the OS of the transplanted patient from Italian cohort and data from Ok et al (OS at 2 years, 34% vs 65% vs 42% respectively) [16,75,105]. Retrospective analysis specifically addressing outcomes post-transplant in de novo AML, secondary AML and t-AML showed comparable outcomes regarding OS and leukemiafree survival [106]. Monosomal karyotype, adverse cytogenetics, unrelated donor, and high comorbidity index are all associated with worse outcomes in transplanted patients.…”

Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia

“…Both subgroups achieved comparable outcomes and were associated with increased OS, LFS and GRFS following alloSCT in CR1. Hence, as suggested earlier, the described two subtypes might be grouped as sAML in the setting of alloSCT 12 , although our numbers were to small to compare outcome of sAML following MDS versus sAML versus MPN. Due to the retrospective nature of our study, some limitations, including missing information on MRD status and pre-and post-transplant therapies in most patients, must be acknowledged.…”

“…So far, only smaller studies have addressed this question 12 . Therefore, the Acute Leukemia Working Party (ALWP) of the European Society of Blood and Marrow Transplantation (EBMT) performed a retrospective registry-based analysis, comparing the outcome of adult patients diagnosed with sAML and de novo AML, who had received alloSCT.…”