The impact of cytogenetic risk on the outcomes of allogeneic hematopoietic cell transplantation in patients with relapsed/refractory acute myeloid leukemia: On behalf of the acute leukemia working party (ALWP) of the European group for blood and marrow transplantation (EBMT)

Abstract

Karyotypic analysis at time of diagnosis has an important value in determining initial response to treatment, remission duration and overall survival (OS) in acute myeloid leukemia (AML). Less is known about its value before allogeneic hematopoietic cell transplantation (allo‐HCT) in patients transplanted with active disease, either relapsed or primary refractory (Rel‐Ref) AML. We explored the impact of cytogenetic risk (stratification according to MRC‐UK) in 2089 patients with either Ref (n = 972) or Rel AML (n = 1117) transplanted during the period 2000‐2017. Overall, 154 patients had a favorable risk, 1283 had an intermediate risk and 652 had an adverse cytogenetic risk. Median follow‐up was 49 months. Compared to the favorable risk group, intermediate and adverse risk patients were associated with worse leukemia‐free survival and OS and also with a higher incidence of relapse. In a subgroup analysis of patients in the intermediate risk group harboring Fms‐like tyrosine kinase 3‐internal tandem duplication (FLT3‐ITD), this remained an important prognostic factor, being associated with worse outcomes. When analyzing patients according to the intensity of the conditioning regimen, no differences were observed for the main transplant outcomes. In conclusion, in patients diagnosed with AML and transplanted with active disease, karyotype remains an important prognostic factor, allowing splitting patients into different risk groups according to their cytogenetics. Similarly, FLT3‐ITD mutation also remains a negative prognostic factor in this population.

Optimized therapeutic strategy for patients with refractory or relapsed acute myeloid leukemia: long‐term clinical outcomes and health‐related quality of life assessment

“…The present study also suggested that total therapy was associated with a TRM of 19.0% at 2 years and 22.1% at 5 years after transplantation. This result was comparable with those of previous studies conducted on patients with refractory or relapsed AML (2-year TRM: 19% vs. 16%-26%) [4][5][6][7][8] and on patients with AML in first complete remission (CR1) or CR2 (2-year TRM: 19.0% vs. 13.0%-20.0%) [15,33]. These results demonstrate the safety of total therapy.…”

“…40.0%‐60.0% and 2‐ year LFS: 51.4% vs . 20.0%‐40.0%) [ 4 , 5 , 6 , 7 , 8 ]. Moreover, this result is also similar to that in patients with AML in second complete remission (CR2) (2‐year CIR: 29.5% vs .…”

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…”

A novel intensive conditioning regimen for allogeneic hematopoietic stem cell transplantation in the treatment of relapsed/refractory acute myeloid leukemia

“…Besides mutation in fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD), is also an important risk factor in R/R AML patients, being associated with worse outcomes. Poiani et al [30] explored the impact of cytogenetic risk on the outcomes of allo-HSCT in patients with R/R acute myeloid leukemia. They showed that compared to the favorable risk group, inter-mediate and adverse risk patients were associated with worse leukemia-free survival and OS and also with a higher incidence of relapse.…”