Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

Abstract

Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo‐SCT) with a reduced performance status. We herein present the results of a registry study on 2,936 AML patients undergoing allo‐SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two‐year leukemia‐free survival (LFS), overall survival (OS) and graft‐versus‐host disease (GVHD)‐free, and relapse‐free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non‐relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% (p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced‐intensity conditioning (RIC) regimen was associated with an increased risk of relapse (p = 0.002) and lower GRFS (p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM (p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS (p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III‐IV acute GVHD (p < 0.01) and NRM (p < 0.01) in comparison to other donor types. In conclusion, allo‐SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment.

Dose intensity for conditioning in allogeneic hematopoietic cell transplantation: can we recommend “when and for whom” in 2021?

“…Patients with a Karnofsky performance status of 80% benefited more from MAC, while patients with a performance status <80% benefited more from RIC. 73 In conclusion, simple recommendation of RIC/NMA for older unfit patients or MAC for young and fit ones is not reflected by current evidence. Neither age nor comorbidities are associated with significantly different outcomes for these categorizations.…”

“…Patients with a Karnofsky performance status of 80% benefited more from MAC, while patients with a performance status <80% benefited more from RIC. 73 …”

Conditioning Regimens for Frail Patients with Acute Leukemia Undergoing Allogeneic Stem Cell Transplant: How to Strike Gently

“…To date, historical models such as KPS and the Eastern cooperative oncology group performance status remain as the most widely accepted “frailty” measures in pre-HSCT evaluation. A recent study by the Acute Leukemia Working Party (ALWP)-EBMT [ 15 ] analysed transplant outcome in patients with a reduced KPS (≤80%), including almost 3000 patients with AML undergoing transplant in remission. As expected, patients with a KPS score = 80% had lower non-relapse mortality (NRM) and superior overall survival (OS) in comparison to patients with a KPS score <80% ( p < 0.001).…”

The impact of MICB mismatches in unrelated haematopoietic stem cell transplantation

“…In‐vivo T‐cell depletion showed better OS, GRFS as well as lower GvHD and relapse incidences 36 . Finally, a Karnofsky performance score lower than 80 was highly predictive of treatment failure 37 . Specific features of our cohort were a very high proportion of PBSC grafts greater than 90%.…”

“…36 Finally, a Karnofsky performance score lower than 80 was highly predictive of treatment failure. 37 Specific features of our cohort were a very high proportion of PBSC grafts greater than 90%. About 2 thirds of the patients received in-vivo T-cell depletion with ATG of Campath as part of the conditioning treatment reflecting current clinical practice in Germany.…”