Frequency of Allogeneic Hematopoietic Cell Transplantation Among Patients With High- or Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission

Abstract

Purpose To determine the frequency of allogeneic hematopoietic cell transplantation (HCT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1). Patients and Methods Between January 1, 2008, and March 1, 2011, 212 newly diagnosed patients with AML received treatment at our center. Ninety-five patients age less than 75 years with intermediate- or high-risk AML achieved a complete remission, and 21 patients achieved a morphologic remission with incomplete blood count recovery. Results Seventy-eight (67%; 95% CI, 58% to 76%) of 116 patients received HCT at a median of 2.8 months (range, 0.5 to 19 months) from their CR1 date. The median age was 57 years in both the HCT patient group (range, 18 to 75 years) and the non-HCT patient group (range, 24 to 70 years; P = .514). Between the HCT patients and the non-HCT patients, the mean Eastern Cooperative Oncology Group performance status was 1.1 compared with 1.5, respectively (P = .005), and the average HCT comorbidity score within 60 days of CR1 was 1.7 and 2.1, respectively (P = .68). Twenty-nine (76%) of 38 non-HCT patients were HLA typed, and matched donors were found for 13 of these 29 patients (34% of all non-HCT patients). The most common causes for patients not receiving transplantation in CR1 were early relapse (within 6 months) in 12 patients (32%), poor performance status in eight patients (21%), and physician decision in five patients (13%). Conclusion HCT can be performed in CR1 in the majority of patients with AML for whom it is currently recommended. The main barriers to HCT were early relapse and poor performance status, highlighting the need for improved therapies for patients with AML of all ages.

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes: Lingering Uncertainties and Emerging Possibilities

“…Limited understanding of referring physicians regarding transplant eligibility, late transplant referrals, delay in HLA typing, and underuse of URD transplantation is also responsible. The feasibility of surmounting some of these barriers was demonstrated in a recent study in which a combination of pragmatic strategies, including use of alternative donors, different graft sources, and RIC regimens (42%), allowed 67% of AML patients in complete remission to proceed to HCT [13]. A concerted effort in educating the clinicians providing care for MDS patients would result in more frequent and earlier consideration of this modality.…”

Are we curing more older adults with acute myeloid leukemia with allogeneic transplantation in CR1?

“…The primary reason is development of RIC regimens, which enable older patients to be treated relying largely on graft-versusleukemia effects rather than myeloablative chemotherapy to eliminate malignant cells. With the advent and success of RIC transplants and identification of alternative donors, the number of ASCT in older adults is increasing, though it still only represents 10% or less of the transplant population [53,54]. The University of Minnesota demonstrated the efficacy of alternative donor sources in AML patients aged at least 50 [55 & ].…”

Acute myeloid leukemia: 2016 Update on risk‐stratification and management

“…19) [103] An analysis comparing patients with and without allo HCT donors ("genetic randomization") reported an advantage for the donor group as a surrogate for RIC [104]. However, donor vs. no donor methodology is less useful with the increasing use of alternative donors [105], emphasizing the important possibility of selection bias in comparisons of allo HCT vs. not [106].…”