Allogeneic HCT Effective in Older Patients with AML in Second Complete Remission

Allogenic hematopoietic cell transplantation (HCT) is an effective curative therapy for older patients with acute myeloid leukemia (AML) who are in their second complete remission (CR2). This is especially applicable to patients with favorable or intermediate cytogenetic risk.¹

Allogenic HCT is a procedure in which a patient receives blood-forming stem cells from a genetically similar but not identical donor. Donors can be genetically related or unrelated to the recipient so long as the donor is sufficiently genetically similar.

The procedure provides curative potential to many older patients with AML in their first complete remission, though limited data existed about post-HCT outcomes for older patients with AML in CR2.

This study retrospectively examined parameters affecting posttransplant outcomes for patients aged 60 years or older with AML in CR2 undergoing HCT. Researchers used the Center for International Blood and Marrow Transplant Research database.

For this study, researchers identified 196 patients from 78 centers. The median age was 64 years (range, 60 to 78 years). At the time of HCT, 71% of patients had a Karnofsky performance status of 90 or greater. Karnofsky performance status assesses general wellbeing and ranges from 0 (death) to 100 (“perfect” health).

Univariate analysis revealed a 3-year overall survival (OS) rate of 42% (95% CI, 35-49), a disease-free survival rate of 37% (95% CI, 30-44), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19-32), and a cumulative incidence of relapse of 38% (95% CI, 31-45).

Multivariate analysis revealed that only cytogenetic risk was an independent risk factor for OS (P =.023), with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for high-risk cytogenetics.

For cumulative incidence of relapse, cytogenetic risk was the only independent risk factor (P =.01), with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for high-risk cytogenetics.

Reference

1. Michelis FV, Gupta V, Zhang MJ , et al. Cytogenetic risk determines outcomes after allogeneic transplantation in older patients with acute myeloid leukemia in their second complete remission: a Center for International Blood and Marrow Transplant research cohort analysis. Cancer. 2017 Jan 24. doi: 10.1002/cncr.30567 [Epub ahead of print]