Journal Article

An adapted European LeukemiaNet genetic risk stratification for acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplant. A CIBMTR analysis

Melhem, Solh, Abid Muhammad Bilal, Komanduri, Krishna V, Copelan, Edward, Castillo, Paul, Olsson, Richard F, Jimenez Jimenez Antonio M, De Lima Marcos, Baron, Frédéric, Maakaron, Joseph, Wang, Trent P, Hourigan, Christopher S, Michelis, Fotios V, Mishra Asmita, Nishihori Taiga, Kansagra Ankit, Verdonck, Leo F, Chen, Karen, Yared, Jean A, Kharfan-Dabaja Mohamed A, Grunwald, Michael R, Aljurf Mahmoud, Milone Giuseppe, Seo Sachiko, Zhang, Mei-Jie, Assal Amer, Martino, Rodrigo, McGuirk, Joseph, Khera Nandita, Litzow, Mark, Weisdorf, Daniel, Wirk Baldeep, Alkhateeb Hassan, Bacher Ulrike, Saber Wael, Kanakry, Christopher G, Nathan, Sunita, Abdel-Azim Hisham, Patel, Sagar, Biju, George, Saad Ayman, Murthy, Hemant S, Palmisiano Neil, Bhatt, Vijaya Raj, Hildebrandt, Gerhard C, Battiwalla Minoo, Cairo, Mitchell, Perez Miguel Angel Diaz, Mussetti Alberto, Elsawy Mahmoud, Byrne, Michael, Cahn Jean-Yves, Gale, Robert Peter, Zachariah, DeFilipp, Kebriaei Partow, Bejanyan Nelli, Hogan, William J, Lazaryan Aleksandr, Sharma, Akshay, Beitinjaneh Amer, Krem, Maxwell M

2021

Overview

Cytogenetic and molecular abnormalities are known to influence post-transplant outcomes in acute myeloid leukemia (AML) but data assessing the prognostic value of combined genetic models in the HCT setting are limited. We developed an adapted European LeukemiaNet (aELN) risk classification based on available genetic data reported to the Center for International Blood and Marrow Transplant Research, to predict post-transplant outcomes in 2289 adult AML patients transplanted in first remission, between 2013 and 2017. Patients were stratified according to aELN into three groups: favorable (Fav, N = 181), intermediate (IM, N = 1185), and adverse (Adv, N = 923). Univariate analysis demonstrated significant differences in 2-year overall survival (OS) (Fav: 67.7%, IM: 64.9% and Adv: 53.9%; p < 0.001); disease-free survival (DFS) (Fav: 57.8%, IM: 55.5% and Adv: 45.3; p < 0.001) and relapse (Fav: 28%, IM: 27.5% and Adv: 37.5%; p < 0.001). Multivariate analysis (MVA) revealed no differences in outcomes between the Fav and IM groups, thus they were combined. On MVA, patients in the Adv risk group had the highest risk of relapse (HR 1.47 p ≤ 0.001) and inferior DFS (HR 1.35 p < 0.001) and OS (HR 1.39 p < 0.001), even using myeloablative conditioning or in those without the pre-HCT measurable-residual disease. Novel approaches to mitigate relapse in this high-risk group are urgently needed.

• Publisher: Nature Publishing Group
• Subject: Abnormalities / Acute myeloid leukemia / Cytogenetics / Disease control / Health risk assessment / Leukemia / Multivariate analysis / Myeloid leukemia / Remission / Risk / Risk groups / Stem cell transplantation / Survival