Prognostic Impact of Donor Source on Allogeneic Hematopoietic Stem Cell Transplantation Outcomes in Adults with Chronic Myelomonocytic Leukemia: A Nationwide Retrospective Analysis in Japan

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapeutic option for patients with chronic myelomonocytic leukemia (CMML). We retrospectively compared the post-transplantation outcomes of 159 patients with CMML who underwent allo-HSCT using 4 types of donor sources: HLA-matched related donor graft, unrelated bone marrow (U-BM), unrelated cord blood (U-CB), and HLA-mismatched related donor graft. The median patient age at allo-HSCT was 54 years (range, 16 to 75 years). In multivariate analyses, the use of HLA-matched related donor grafts correlated with better overall survival than U-BM (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.21 to 3.48; P = .008), U-CB (HR, 3.80; 95% CI, 2.07 to 6.95; P < .001), or HLA-mismatched related donor grafts (HR, 6.18; 95% CI, 2.70 to 14.15; P < .001). Mortality after the relapse or progression of CMML did not significantly differ among the 4 types of donor source. Transplantation-related mortality was highest in recipients of U-CB (HR, 3.32; 95% CI, 1.33 to 8.26; P = .010). In patients with CMML, allo-HSCT using an alternative donor may contribute to durable remission; however, further improvements in transplantation-related mortality are required for this type of transplantation.

Haploidentical stem cell transplantation in patients with chronic myelomonocytic leukemia

“…However, neither of these studies included patients under haplo-SCT. Among a Japanese retrospective study with various donor sources, the 3-year OS of 12 patients who received transplants from human leukocyte antigen-mismatched related donors was only 16.7% (Itonaga et al, 2018). It is significantly inferior to our study.…”

Impact of clinical, cytogenetic, and molecular profiles on long-term survival after transplantation in patients with chronic myelomonocytic leukemia

“…19,20 The only therapeutic modality with proven curative potential is allogenic hematopoietic cell transplantation (HCT). [21][22][23][24][25][26][27] Published data indicate that the major factors determining long-term relapse-free survival and overall survival are cytogenetic risk category, comorbidities, patient's age and achievement of complete remission. 21,[25][26][27] In the present study, we analyzed long-term outcomes after allogenic HCT for patients with CMML and, in a subcohort, carried out a comprehensive mutation analysis of 75 genes implicated in myeloid malignancies to define the relationship between somatic mutations and previously established risk factors.…”

Successful management of therapy‐related chronic myelomonocytic leukemia with cytarabine, aclarubicin, and azacitidine following tegafur/gimeracil/oteracil

“…In CMML, response rates and nonrelapse mortality after allogeneic SCT were reported to be 17%–50% and 12%–52%, respectively 1 . Additionally, some retrospective studies reported a variety of factors as predictors of OS after allogeneic SCT for patients with CMML, for example, complete remission, good performance status, and improvement of CPSS score just before allogeneic SCT and within 12 months of transplantation after diagnosis on multivariate analysis 13‐15 . In our patient, CA‐AZA therapy provided a rapid response, an improvement of CPSS, and achievement of almost all CR criteria with keeping performance status, which enabled the patient to undergo allogeneic SCT 5 months after the initial diagnosis.…”