Cytogenetic risk score maintains its prognostic significance in AML patients with detectable measurable residual disease undergoing transplantation in remission: On behalf of the acute leukemia working party of the European society for blood and marrow transplantation

Abstract

While evidence for measurable residual disease (MRD) is a harbinger of inferior outcome in acute myeloid leukemia (AML) patients referred for allogeneic stem cell transplantation (allo‐SCT), the exact clinical trajectory of specific patient subsets in this clinical setting is undefined. Using a recently published prognostic cytogenetic model (Canaani et al. Leukemia 2019) we evaluated whether this model applied also to studies of patients with positive MRD. The analysis comprised MRD+ patients in first complete remission undergoing allo‐SCT from a matched sibling donor or unrelated donor. Seven hundred and seventy‐five patients were evaluated with a median follow‐up duration of 22 months. Cytogenetic risk score was favorable, intermediate/FLT3wt intermediate/FLT3‐ITD3, and adverse in 15%, 28.3%, 37% and 19.7% of the patients, respectively. Favorable and intermediate/FLT3wt risk patients had 2‐year leukemia‐free survival rates of 78% and 61%, respectively, compared with only 50% and 37% for intermediate/FLT3‐ITD3 and adverse risk patients, respectively (P < .001). In multivariate analysis adverse and intermediate/FLT3‐ITD3 risk patients were more likely to experience disease relapse compared with favorable risk patients [hazard ratio (HR) = 3.9, 95% confidence interval (CI), 2.1‐7.3; P < .001, and HR = 4.4, CI 95%, 2.4‐7.8; P < .001, respectively]. The European society for blood and marrow transplantation cytogenetic risk score is a valuable adjunct for risk stratification of MRD+ AML patients.

Human leukocyte antigen‐haploidentical transplantation for relapsed/refractory acute myeloid leukemia: Better leukemia‐free survival with bone marrow than with peripheral blood stem cells in patients ≥55 years of age

“…Comorbidities at transplantation were determined using the hematopoietic cell transplantation‐specific comorbidity‐index (HCT‐CI) score 14 . Cytogenetic risk was stratified according to the MRC‐UK classification, as previously reported 15,16 …”

“…14 Cytogenetic risk was stratified according to the MRC-UK classification, as previously reported. 15,16…”

Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

“…Comorbidities at transplantation were quantified using the hematopoietic cell transplantation-specific comorbidity-index (HCT-CI) score [25]. Cytogenetic risk was stratified using the MRC-UK classification, as previously reported [26,27].…”

Complex karyotype but not other cytogenetic abnormalities is associated with worse posttransplant survival of patients with nucleophosmin 1‐mutated acute myeloid leukemia: A study from the European Society for Blood and Marrow Transplantation Acute Leukemia Working Party

“…24,25 Recent data has also shown the prognostic impact of cytogenetics even in the era of molecular classification of AML with its targeted therapies, 26 as well as the MRD directed management approaches. 27 This analysis again shows the significance of disease status at transplant (MRD positivity has significant impact on almost all posttransplant outcomes). Addtionally, our data indicate a significant impact of the type of donor on posttransplant outcomes where both haploidentical and unrelated donor were associated with significantly higher NRM (HR 2.44, 95% CI 1.69-3.5 and HR 1.69; 95% CI 1.29-2.19, respectively), and worse OS (HR 1.32; 95% CI 0.038 and HR 1.32; 95% CI 1.12-1.55, respectively).…”