Journal Article

Impact of pre-transplant induction and consolidation cycles on AML allogeneic transplant outcomes: a CIBMTR analysis in 3113 AML patients

Lin, Richard, Perez, Miguel Angel Diaz, Cerny, Jan, Wagner, John L, Castillo, Paul, Bejanyan, Nelli, Wang, Trent, Kebriaei, Partow, Brown, Valerie I, Lazarus, Hillard M, Hourigan, Christopher S, Modi, Dipenkumar, Ganguly, Siddhartha, Patel, Sagar S, Khera, Nandita, Battiwalla, Minoo, Saber, Wael, Kharfan-Dabaja, Mohamed A, Chen, Karen, Abdel-Azim, Hisham, Grunwald, Michael R, Nishihori, Taiga, Zhang, Mei-Jie, Gowda, Lohith, Bacher, Ulrike, Litzow, Mark, Zeidan, Amer, Wirk, Baldeep, Abid, Muhammad Bilal, Iqbal, Madiha, Aljurf, Mahmoud, Williams, Kirsten M, Nathan, Sunita, Boyiadzis, Michael, Winestone, Lena E, Hashmi, Shahrukh, Bhatt, Vijaya Raj, Hildebrandt, Gerhard C, Craddock, Charles, Pawarode, Attaphol, Dholaria, Bhagirathbhai, Page, Kristin, Weisdorf, Daniel J, Badawy, Sherif M, Solh, Melhem, de Lima, Marcos, Gale, Robert Peter, Copelan, Edward A, Ebens, Christen L, Sharma, Akshay, Jamy, Omer, Badar, Talha

2023

Overview

We investigated the impact of the number of induction/consolidation cycles on outcomes of 3113 adult AML patients who received allogeneic hematopoietic cell transplantation (allo-HCT) between 2008 and 2019. Patients received allo-HCT using myeloablative (MAC) or reduced-intensity (RIC) conditioning in first complete remission (CR) or with primary induction failure (PIF). Patients who received MAC allo-HCT in CR after 1 induction cycle had 1.3-fold better overall survival (OS) than 2 cycles to CR and 1.47-fold better than ≥3 cycles. OS after CR in 2 or ≥3 cycles was similar. Relapse risk was 1.65-fold greater in patients receiving ≥3 cycles to achieve CR. After RIC allo-HCT, the number of induction cycles to CR did not affect OS. Compared to CR in 1 cycle, relapse risk was 1.24-1.41-fold greater in patients receiving 2 or ≥3 cycles. For patients receiving only 1 cycle to CR, consolidation therapy prior to MAC allo-HCT was associated with improved OS vs. no consolidation therapy. Detectable MRD at the time of MAC allo-HCT did not impact outcomes while detectable MRD preceding RIC allo-HCT was associated with an increased risk of relapse. For allo-HCT in PIF, OS was significantly worse than allo-HCT in CR after 1–3 cycles.

• Publisher: Nature Publishing Group
• Subject: Allografts / Consolidation / Hematopoietic stem cells / Remission / Risk / Stem cell transplantation / Transplantation / Transplants & implants