Risk factors for post-transplant relapse and survival in younger adult patients with t(8;21)(q22;q22) acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation: A multicenter retrospective study

• Published in: Frontiers in oncology Vol. 13; p. 1138853
• Main Authors: Zhou, Wei, Chen, Guofeng, Gong, Dan, Gao, Yi, Yu, Li
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 09.02.2023
• Subjects: acute myeloid leukemia; allogeneic hematopoietic stem cell transplantation; minimal residual disease; Oncology; relapse; RUNX1/RUNX1T1; t(8;21); minimal residual disease; acute myeloid leukemia; relapse; RUNX1/RUNX1T1; t(8;21); allogeneic hematopoietic stem cell transplantation
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2023.1138853

Outcomes of patients with t(8;21)(q22;q22) acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain heterogeneous. To identify the risk factors for relapse and survival after allo-HSCT in t(8;21) AML patients, we retrospectively evaluated the clinical and prognostic information of 142 patients with t(8;21) AML undergoing allo-HSCT between January 2002 and September 2018 at 15 hematology research centers in China. Twenty-nine patients (20%) relapsed after undergoing allo-HSCT. A > 1-log reduction in -based minimal residual disease (MRD) directly before allo-HSCT and a > 3-log reduction within the first 3 months after allo-HSCT were associated with a significantly lower post-transplant 3-year cumulative incidence of relapse (CIR, 9% vs. 62% and 10% vs. 47%,all < 0.001), whereas transplantation during the second complete remission (CR2, 39% vs. 17% during CR1, = 0.022), during relapse (62% vs. 17% during CR1, < 0.001) and mutations at diagnosis (49% vs. 18%, = 0.039) were related to a significantly higher 3-year CIR. Multivariate analysis demonstrated that a > 1-log reduction in MRD directly before transplantation (CIR: hazard ratio(HR), 0.21 [0.03-0.71], = 0.029; overall survival (OS): HR = 0.27 [0.08-0.93], = 0.038) and a > 3-log reduction in post-transplant MRD within the first 3 months (CIR: HR = 0.25 [0.07-0.89], = 0.019; OS: HR = 0.38 [0.15-0.96], = 0.040) were independent favorable prognostic factors, and transplantation during relapse (CIR: HR = 5.55 [1.23-11.56], = 0.041; OS: HR = 4.07 [1.82-20.12], = 0.045) were independent adverse prognostic factors for post-transplant relapse and survival in patients with t(8;21) AML. Our study suggests that for patients with t(8;21) AML undergoing allo-HSCT, it would be better to receive transplantation during CR1 with a MRD directly before transplantation achieving at least 1-log reduction. MRD monitoring in the first 3 months after allo-HSCT might be robust in predicting relapse and adverse survival after allo-HSCT.