Prognostic index for patients with relapsed or refractory acute myeloid leukemia who underwent hematopoietic cell transplantation: a KSGCT multicenter analysis

• Published in: Leukemia Vol. 33; no. 11; pp. 2610 - 2618
• Main Authors: Tachibana, Takayoshi, Kanda, Junya, Ishizaki, Takuma, Najima, Yuho, Tanaka, Masatsugu, Doki, Noriko, Fujiwara, Shin-ichiro, Kimura, Shun-ichi, Onizuka, Makoto, Takahashi, Satoshi, Saito, Takeshi, Mori, Takehiko, Fujisawa, Shin, Sakaida, Emiko, Matsumoto, Kenji, Aotsuka, Nobuyuki, Goto, Moritaka, Watanabe, Reiko, Shono, Katsuhiro, Usuki, Kensuke, Tsukada, Nobuhiro, Kanamori, Heiwa, Kanda, Yoshinobu, Okamoto, Shinichiro
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2019; Nature Publishing Group
• Subjects: 692/499; 692/699/1541/1990/283/1897; Acute myeloid leukemia; Adolescent; Adult; Aged; Bone marrow; Bone marrow transplantation; C-reactive protein; Cancer Research; Cells; Critical Care Medicine; Failure analysis; Female; Graft vs Host Disease; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Intensive; Internal Medicine; Karyotypes; Leukemia; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - pathology; Leukemia, Myeloid, Acute - therapy; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Multivariate Analysis; Myeloid leukemia; Neoplasm Recurrence, Local; Oncology; Peripheral blood; Prognosis; Remission Induction; Retrospective Studies; Stem cell transplantation; Stem cells; Survival; Transplantation; Transplantation Conditioning; Treatment Outcome; Young Adult
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/s41375-019-0494-9

A multicenter retrospective study was performed to explore a prognostic scoring index in order to identify a population who are least likely to benefit from allogeneic hematopoietic cell transplantation (HCT) in patients with relapsed or refractory acute myeloid leukemia (AML). The cohort included 519 patients with AML, who received HCT between 2005 and 2015 at a status of relapse or primary induction failure. Multivariate analysis demonstrated five independent predictors for OS, including C-reactive protein ≥ 1 mg/dL, peripheral blood blast fraction ≥ 20%, poor-risk karyotype, performance status ≥ 2, and bone marrow unrelated donor as a stem cell source. A prognostic scoring index was explored based on these predictors, and successfully separated the cohort into four groups. At 2 years, OS was 47%, 24%, 8%, and 0% for Good (Score 0, 1: n  = 118), Intermediate-1 (Score 2: n  = 75), Intermediate-2 (Score 3: n  = 39), and Poor (Score 4: n = 24), respectively ( P  < 0.001). The predicting value of the index was confirmed in a validation cohort. Although a further validation study is warranted, the scoring index may be useful to predict survival and to identify the population with the lowest survival prior to HCT in patients with relapsed or refractory AML.