Better leukemia-free survival with allogeneic than with autologous HCT in AML patients with isolated trisomy 8: a study from the ALWP of the EBMT

Abstract

The indication for performing an allogeneic hematopoietic stem cell transplantation (allo-HCT) in patients with isolated trisomy 8 AML in first complete remission (CR) is still debated. Here, we compared outcomes of such patients given either allo-HCT or autologous (auto)-HCT. Inclusion criteria consisted of adult patients with de novo AML, isolated trisomy 8, first HCT between 2000 and 2018, CR1 at transplantation, and either auto-HCT or allo-HCT with a HLA-identical sibling donor (MSD) or a 10/10 HLA-matched unrelated donor (UD 10/10). A total of 401 patients met the inclusion criteria. They underwent an auto-HCT (n = 81), allo-HCT with a MSD (n = 186) or allo-HCT with a 10/10 UD (n = 134). At 3 years, relapse incidence, nonrelapse mortality and leukemia-free survival (LFS) were 59%, 5%, and 37%, respectively, in auto-HCT recipients; 31% (P < 0.001), 14% (P = 0.04), and 55% (P = 0.033), respectively, in MSD recipients and 29% (P < 0.001), 13% (P = 0.15), and 59% (P = 0.03), respectively, in UD 10/10 recipients. In multivariate analysis, in comparison to auto-HCT, MSD and UD 10/10 were associated with a lower risk of relapse (HR = 0.47, P < 0.001 and HR = 0.40, P < 0.001, respectively) translating to better LFS (HR = 0.69, P = 0.04 and HR = 0.60, P = 0.03, respectively). There was also a similar trend for overall survival (HR = 0.73, P = 0.12 and HR = 0.65, P = 0.08).

Risk Stratification, Measurable Residual Disease, and Outcomes of AML Patients with a Trisomy 8 Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

“…This assumption was recently confirmed by the EBMT that reported on 401 AML patients with an isolated trisomy 8 transplanted either with autologous or HLA-matched allogeneic HSCT in first remission. In this study, patients receiving allogeneic HSCT had a lower cumulative incidence of relapse (CIR), and-despite a higher non-relapse mortality (NRM)-longer RFS as well as a trend for longer overall survival (OS) [12]. Additionally, single center as well as registry-based analyzes indicated promising outcomes in larger cohorts of patients with a trisomy 8, further pointing to allogeneic HSCT as an effective consolidation treatment in these patients [10,13].…”

“…Regarding the optimal consolidation therapy in trisomy 8 patients, it has been suggested that chemotherapy alone may not have the ability to cure trisomy 8 AML [2,8], which was further underlined by a study by the EBMT showing more beneficial outcomes for trisomy 8 patients undergoing allogeneic HSCT compared to autologous HSCT consolidation [12]. Nevertheless, so far, no study compared outcomes of patients with or without a trisomy 8 after allogeneic HSCT.…”

“…An allogeneic hematopoietic stem cell transplantation (HSCT) is a suitable postremission consolidation therapy approach, especially for AML patients with intermediate or high-risk AML [11]. Several retrospective studies already suggested that an allogeneic HSCT might be beneficial for patients harboring a trisomy 8 [8,10,12,13]. In a meta-analysis of the German AML intergroup which analyzed trisomy 8 as either a sole aberration or in combination with one additional genetic variation, patients consolidated by allogeneic HSCT showed improved relapse-free survival (RFS) compared to patients undergoing chemotherapy consolidation or autologous HSCT [8].…”

Comparison of long-term outcome for AML patients alive free of disease 2 years after allogeneic hematopoietic cell transplantation with umbilical cord blood versus unrelated donor: a study from the ALWP of the EBMT

“…Allogeneic hematopoietic stem cell transplantation (allo-HCT) has remained the best curative option for patients with poor or intermediate-risk AML in first complete remission (CR) as well as for AML patients in second CR (CR2) [1][2][3][4][5]. For patients who lack a fit HLA-identical sibling donor, transplantation with either an HLAmatched or HLA-mismatched unrelated donor (UD), HLAhaploidentical or umbilical cord blood (CB) donor has remained an adequate option.…”