Depth of Response to Intensive Chemotherapy Has Significant Prognostic Value among Acute Myeloid Leukemia (AML) Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation with Intermediate or Adverse Risk at Diagnosis Compared to At-Risk Group According to European Leukemia Net 2017 Risk Stratification

Abstract

We evaluated the prognostic efficiency of the European Leukemia Net (ELN) 2017 criteria on the post-transplant outcomes of 174 patients with intermediate (INT; n = 108, 62%) or adverse (ADV) risk (n = 66, 38%) of acute myeloid leukemia; these patients had received the first allogeneic hematopoietic stem-cell transplantation (HSCT) at remission. After a median follow-up period of 18 months, the 2 year OS, RFS, and CIR after HSCT were estimated to be 58.6% vs. 64.4% (p = 0.299), 50.5% vs. 53.7% (p = 0.533), and 26.9% vs. 36.9% (p = 0.060) in the INT and ADV risk groups, respectively. Compared to the ELN 2017 stratification, pre-HSCT WT1 levels (cutoff: 250 copies/104 ABL) more effectively segregated the post-HSCT outcomes of INT risk patients compared to ADV risk patients regarding their 2 year OS (64.2% vs. 51.5%, p = 0.099), RFS (59.4% vs. 32.4%, p = 0.003), and CIR (18.9% vs. 60.0% p < 0.001). Indeed, high WT1 levels were more prominent in INT risk patients than in ADV risk patients. Notably, FLT3-ITD had the greatest impact on post-HSCT outcomes among all the ELN 2017 criteria components; patients in the FLT3-ITD mutant subgroups exhibited the worst outcomes regardless of their allelic ratios or NPM1 status compared to the pre-HSCT WT1 level of other INT and ADV risk patients.

A Successful Bridge Therapy Combining Hypomethylating Agents with Venetoclax for Adult Patients with Newly Diagnosed or Relapsed/Refractory Acute Myeloid Leukemia

“…According to the ELN 2022 risk classification [ 27 ], the favorable (FAV), intermediate (INT), and adverse (ADV) risk groups comprised 10.0%, 50.0%, and 40.0%, respectively, and most patients (70.0%) had INT-risk cytogenetics. Cytogenetics and genetic mutation tests required for ELN classification were performed in all patients as previously described [ 21 , 28 , 29 , 30 , 31 ]. All patients were treated with DEC as the agent combined with VEN, and patients received a median of four cycles (range, 3–7) of VEN-DEC prior to allo-HCT.…”

“…GVHD prevention involved the use of either cyclosporine in the case of transplantation from an MSD or tacrolimus for transplantation from other donors, along with methotrexate. Patients who underwent umbilical CBT were administered mycophenolate mofetil thrice a day at a dosage of 3 g. Patients who had a UD or HID received a dosage of 1.25 mg/kg of anti-thymocyte globulin (ATG) once daily for 2 days (D-3 to D-2) and 4 days (D-4 to D-1), respectively, whereas it was not a standard practice to administer ATG to patients who had an MSD [ 21 , 22 ].…”