Duration of first remission, hematopoietic cell transplantation-specific comorbidity index and patient age predict survival of patients with AML transplanted in second CR

Abstract

Allo-SCT is potentially curative for patients with AML. Patients transplanted in CR2 tend to experience inferior survival compared with those in CR1. We retrospectively investigated the impact of pretransplant variables on the outcome of patients transplanted with AML in CR2. Ninety-four patients with AML in CR2 received a transplant between 1999 and 2011 with myeloablative (MA, n ¼ 65) or reduced-intensity conditioning regimens (RIC, n ¼ 29). Variables investigated included cytogenetic risk at diagnosis (SWOG), hematopoietic cell transplantation-specific comorbidity index (HCT-CI), CMV status, duration of CR1 and age. Median age of all patients was 47 years (range 18-70). Multivariable analysis for OS identified three prognostically significant categories: a favorable risk group included patients with duration of CR1 X6 months, age o55 years and HCT-CI score 0-3, an intermediate risk group with duration of CR1 X6 months, age o55 years and HCT-CI score 4-5 and a high-risk group with duration of CR1 o6 months or age X55 years (P ¼ 0.0001) with 5-year survivals of 53%, 31% and 6%, respectively. Acute and chronic GVHD did not influence this risk stratification. The stated risk factors discriminate patients with different OS and may assist in decision making for allo-SCT.

Duration of first remission and hematopoietic cell transplantation-specific comorbidity index but not age predict survival of patients with AML transplanted in CR2: a retrospective multicenter study

“…Age groups were dichotomized at ⩾ 55 years, duration of CR1 at ⩾ 6 months and HCT-CI 0-3 or more. Distribution of patients into risk groups as defined by Michelis et al 6 was documented for both the original single-center and the multicenter cohort. Contingency statistics were used to compare the distribution of patient characteristics between the two cohorts.…”

“…Data from the original study were used to compare the distribution of variables and outcomes with the multicenter cohort. The collection of data focused on the three prognostic parameters previously identified in the single-center study: 6 patient age at transplant, duration of CR1, HCT-CI, as well as donor type, conditioning regimen intensity, duration of follow-up and survival status. Cytogenetics at diagnosis were not evaluated.…”

“…Univariate analysis for the influence of the previously described variables on OS was calculated using the Kaplan-Meier product-limit method and log-rank test. This included univariate analysis for stratification of patients into the three risk groups as defined by Michelis et al, 6 as follows: Group A (favorable risk) with duration of CR1 ⩾ 6 months, age at HCT o55 years and HCT-CI 0-3, Group B (intermediate risk) with duration of CR1 ⩾ 6 months, age at HCT o55 years and HCT-CI ⩾ 4 and Group C (unfavorable risk) with duration of CR1 o6 months and/or age at HCT ⩾ 55 years. P-values were two-sided and for the statistical analyses, P o 0.05 was considered to indicate a significant difference.…”

Predictive value of risk assessment scores in patients with hematologic malignancies undergoing reduced‐intensity conditioning allogeneic stem cell transplantation

“…On the other hand, Barba et al reported that a flexible HCT-CI was more useful than original HCT-CI for predicting the outcome of such patients [9]. In addition, Michelis et al reported that patients with an HCT-CI of 0-3 had better overall survival [5], but this was a different cut-off value from the original one. These two reports suggested that altering the cut-off value could improve the validity of the HCT-CI.…”

“…On the other hand, PAM score is a global risk assessment score including variable factors of comorbidity, condition of transplantation, and disease risk. The usefulness of these risk assessment scores has been validated by some previous studies [3][4][5][6][7][8][9][10][11][12][13], but the scores failed to predict mortality in other reports [14][15][16].…”