Impact of pre-HCT therapy on outcome in patients with AML

Boyiadzis M, Zhang M-J, Chen K, et al. Impact of Pre-Transplant Induction and Consolidation Cycles on AML Allogeneic Transplant Outcomes: A CIBMTR Analysis in 3113 AML Patients. Leukemia. 2022; (doi: 10.1038/s41375-022-01738-3).

Patients with adult acute myeloid leukemia (AML) who underwent myeloablative conditioning (MAC) allogeneic hematopoietic cell transplantation (allo-HCT) in CR after one induction cycle to CR and consolidation treatment had improved overall survival (OS).  The study included 3,113 patients who received allo-HCT with MAC or reduced-intensity (RIC) conditioning in first complete remission (CR) or with primary induction failure (PIF). Overall survival (OS) was 1.3-fold greater for individuals who received MAC allo-HCT in CR after one induction cycle compared with two cycles to CR and 1.47 times greater than for >3 cycles. There were similar rates of OS after CR for two or >3 cycles. Patients who received >3 cycles to achieve CR had a 1.65 times higher risk of relapse. The number of induction cycles to CR after RIC allo-HCT did not affect OS. The relapse risk was 1.24-1.41 times greater in patients who received two or >3 cycles versus one cycle. Consolidation therapy before MAC allo-HCT was associated with improved OS in patients undergoing one cycle to CR compared with no consolidation therapy. There was an increased risk of relapse associated with detectable minimal residual disease (MRD) preceding RIC allo-HCT, but outcomes were not affected by detectable MRD at time of MAC allo-HCT. OS was much lower for allo-HCT in PIF compared with allo-HCT in CR after up to three cycles.

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Tags: AML, AlloHCT, HCT, Allogeneic, T-Cell, Allo HCT, remission, survival rate, acute myeloid leukemia