Allo-HCT outcomes in older and medical infirm AML patients

Soror ML, Gooley TA, Storer BE, et al. An 8-Year Pragmatic Observation Evaluation of the Benefits of Allogeneic HCT in Older and Medically Infirm AML Patients. Blood. 2022; (doi: 10.1182/blood.2022016916).

Allogeneic hematopoietic cell transplantation (HCT) did not yield any benefits for older and medically infirm patients with acute myeloid leukemia (AML), according to a new research. For the prospective, observational study, researchers evaluated connections between HCT and survival, quality of life, function, and geriatric health in six groups: all patients, those ≥65 years, those with high comorbidity burden, intermediate cytogenetic-risk, adverse cytogenetic-risk, and first complete remission with or without measurable residual disease. Patient health and preferences were evaluated eight times over two years. In all, 46% of the 692 evaluable patients underwent HCT with two-year survival of 58%. Although reduced mortality across the entire cohort and most subgroups was related to HCT, such associations vanished when factoring in covariates tied to higher mortality. Patients who chose HCT had improved function, social life, performance status, and depressive symptoms, compared with those who did not, the  health advantages did not continue following HCT. Transplantation recipients and non-recipients expected a cure to be the main therapy goal, while physicians also expected more HCT recipients be cured. Observations from this study suggest that benefit of HCT is most likely due to selection of healthier patients.  Thus, the need for randomized trials to identify the best HCT candidates.   

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Tags: AML, AlloHCT, patient care, allogeneic transplantation, HCT, transplantation, Treatment, Allogeneic, Allo-HCT, abstract, allogeneic HCT, CAR T-cell, transplatation, allogeneic stem cell transplantation, allogeneic hematopoietic stem cell transplant, acute myeloid leukemia