Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia

Yanada, Masamitsu; Konuma, Takaaki; Mizuno, Shohei; Saburi, Masuho; Shinohara, Akihito; Tanaka, Masatsugu; Marumo, Atsushi; Sawa, Masashi; Uchida, Naoyuki; Ozawa, Yukiyasu; Onizuka, Makoto; Yoshioka, Satoshi; Nakamae, Hirohisa; Kondo, Tadakazu; Kimura, Takafumi; Kanda, Junya; Fukuda, Takahiro; Atsuta, Yoshiko; Nakasone, Hideki; Yano, Shingo

doi:10.1038/s41409-020-01032-9

Cited by 18 publications

(9 citation statements)

References 44 publications

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“…Such future analyses should include comparisons with other scoring system not tested in the current study, e.g. the rDRI, 13 the NRM-J index, 14 and/or the SCI. 15 Second, our work was restricted to adults undergoing allogeneic HCT for AML in remission.…”

Section: Discussionmentioning

confidence: 99%

“…Many patient- and disease-specific characteristics have individually been associated with increased mortality after allogeneic HCT, and varying combinations thereof have been integrated into validated prognostic scores. These include, for example, the HCT-specific Comorbidity Index (HCT-CI), 4 – 7 which was designed to capture patient co-morbidities and predict NRM and overall survival (OS) post-HCT, the Pretransplantation Assessment of Mortality (PAM) score, 8 , 9 the (modified) European Society for Blood and Marrow Transplantation (EBMT) risk score, 10 , 11 the Comorbidity-EBMT index, 12 the revised Disease Risk Index (rDRI), 13 the NRM-J index, 14 and the Simplified Comorbidity Index (SCI), 15 among others. While frequently used, existing tools are useful for risk stratification but, at the individual patient level, have relatively limited discriminative capacity.…”

Section: Introductionmentioning

confidence: 99%

“…While frequently used, existing tools are useful for risk stratification but, at the individual patient level, have relatively limited discriminative capacity. 14 , 16 , 17 Hence, there is an ongoing need for new or refined tools to predict NRM and other outcomes following allogeneic HCT.…”

Section: Introductionmentioning

confidence: 99%

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Utility of the Treatment-Related Mortality (TRM) score to predict outcomes of adults with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation

et al. 2022

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There is long-standing interest in estimating non-relapse mortality (NRM) after allogeneic hematopoietic cell transplantation (HCT) for AML, but existing tools have limited discriminative capacity. Using single institution data from 861 adults with AML, we retrospectively examined the treatment-related mortality (TRM) score, originally developed to predict early mortality following induction chemotherapy, as a predictor of post-HCT outcome. NRM risks increased stepwise across the 4 TRM score quartiles (at 3 years: 9% [95% confidence interval: 5–13%] in Q1 vs. 28% [22–34%] in Q4). The 3-year risk of relapse was lower in patients with lower TRM score (26% [20–32%] in Q1 vs. 37% [30–43%] in Q4). Consequently, relapse-free survival (RFS) and overall survival (OS) estimates progressively decreased (RFS at 3 years: 66% [59–72%] in Q1 vs. 36% [29–42%] in Q4; OS at 3 years: 72% [66–78%] in Q1 vs. 39% [33–46%] in Q4). With a C-statistic of 0.661 (continuous variable) or 0.642 (categorized by quartile), the TRM score predicted NRM better than the Pretransplantation Assessment of Mortality (PAM) score (0.603) or the HCT-CI/age composite score (0.576). While post-HCT outcome prediction remains challenging, these findings suggest that the TRM score may be useful for risk stratification for adults with AML undergoing allogeneic HCT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of the Treatment-Related Mortality (TRM) score to predict outcomes of adults with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation

et al. 2022

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“…The EBMT score, including age, disease status, time interval from diagnosis to transplant, donor type and donor recipient sex combination, could improve the selection of HCT candidates [115]. More recently, a Japanese study found that five parameters (namely age, sex, ECOG, HCT-CI and donor type) were associated with NRM and could be used to group patients into low-, intermediate-, high-and very-high-risk categories, with markedly different outcomes after allo-HCT [116].…”

Section: Prognostic Modelsmentioning

confidence: 99%

Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021

Urbino

Secreto

Olivi

et al. 2021

Cancers

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Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.

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“…After randomly dividing 2,344 patients into a training or validation set, this study identified and scored five parameters, namely, age, sex, PS, HCT-specific comorbidity index(HCT-CI) , and donor type, based on their impact on NRM in the patients in the training set. The new scoring system, named＂NRM-J index＂ , uses the sum of the assigned scores to stratify patients into four distinct risk groups 6 . The application of the NRM-J index in the validation set demonstrated a better discriminative capacity than the European Society for Blood and Marrow Transplantation score 7 and HCT-CI 8 .…”

Section: Studies On Patient-related Factorsmentioning

confidence: 99%

Hematopoietic cell transplantation in adults with acute myeloid leukemia: A review of the results from various nationwide registry studies in Japan

Arai

Konuma

Yanada

2021

BCT

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Hematopoietic cell transplantation (HCT) is an integral part of the treatment of acute myeloid leukemia (AML) . Although AML is the most common indication for allogeneic HCT, the relatively small number of patients and the highly complex nature of the procedure often render prospective studies on HCT unfeasible. Observational studies using registry data serve as important sources of information under such circumstances. Thus, the Japanese Society of Hematopoietic Cell Transplantation (JSHCT) has been conducting a nationwide survey of HCT since 1993, and this registration program now covers ＞99% of transplantation centers in Japan. A constant increase in the number of HCT procedures has been noted with recent annual registrations recording more than ＞1,000 new AML patients undergoing allogeneic or autologous HCT. Since its establishment in 2010, the Adult AML Working Group within the JSHCT has been using this registry data to complete several studies focusing on various aspects of HCT in adults with AML, with particular attention paid to patient-, disease-, and transplantation-related factors. This article comprehensively reviews the results obtained from these studies and discusses the strengths and limitations of these kinds of registry-based studies.

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Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia

Cited by 18 publications

References 44 publications

Utility of the Treatment-Related Mortality (TRM) score to predict outcomes of adults with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation

Utility of the Treatment-Related Mortality (TRM) score to predict outcomes of adults with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation

Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021

Hematopoietic cell transplantation in adults with acute myeloid leukemia: A review of the results from various nationwide registry studies in Japan

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