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Relationship between morphologic remission with or without hematologic recovery and outcome after allogeneic hematopoietic cell transplantation in adult acute myeloid leukemia

Bone Marrow Transplantation (2024)Cite this article

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Abstract

Outcomes of adults with AML after allografting vary widely. While numerous covariates have been associated with relapse, non-relapse mortality (NRM), and/or shorter survival, the impact of incomplete blood count recovery before transplantation has remained unclear. To address this uncertainty, we examined all adults with AML or MDS/AML who received an allograft in first or second remission between 2006 and 2023 at a single institution. Of 1264 patients, 891 (70%) met criteria for CR, whereas 291 (23%), 24 (2%), and 58 (5%) were classified as CRh, CRi, and morphologic leukemia-free state (MLFS), respectively. CR, CRh, CRi, and MLFS patients differed significantly regarding demographics, disease biology, pre-transplant measurable residual disease, and types of transplants. After multivariable adjustment, outcomes for CRh and CRi patients were not significantly different from each other or from those of CR patients. In contrast, outcomes of MLFS patients were substantially worse than those of CR and CRh patients, with significantly higher risk of NRM and relapse, and significantly shorter relapse-free and overall survival. Similar results were obtained in several distinct subsets. Together, our analysis provides empiric evidence for the importance of distinguishing MLFS from CR and CRh patients for optimized risk assessment and, possibly, individualized treatment decision making.

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Fig. 1: Post-HCT outcomes for 1,264 adults with AML or MDS/AML undergoing allogeneic HCT while in first or second morphologic remission, stratified by response to pre-HCT therapy/peripheral blood counts.
Fig. 2: Post-HCT outcomes for 1,264 adults with AML or MDS/AML undergoing allogeneic HCT while in first or second morphologic remission, stratified by response to pre-HCT therapy/peripheral blood counts and pre-HCT MRD status.

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For original, de-identified data, please contact the corresponding author (rwalter@fredhutch.org).

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Acknowledgements

Research reported in this publication was supported by grants P01-CA078902, P01-CA018029, and P30-CA015704 from the National Cancer Institute/National Institutes of Health (NCI/NIH), Bethesda, MD, USA. RBW acknowledges support from the José Carreras/E. Donnall Thomas Endowed Chair for Cancer Research.

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Authors and Affiliations

  1. Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Megan Othus

  2. Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Domitilla Baccon, Eduardo Rodríguez-Arbolí, Corentin Orvain, Filippo Milano, Brenda M. Sandmaier & Roland B. Walter

  3. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Naveed Ali, Chris Davis & Ryan S. Basom

  4. Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA

    Naveed Ali, Filippo Milano, Brenda M. Sandmaier & Roland B. Walter

  5. Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/), University of Seville, Seville, Spain

    Eduardo Rodríguez-Arbolí

  6. Maladies du Sang, CHU d’Angers, Angers, France

    Corentin Orvain

  7. Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, Angers, France

    Corentin Orvain

  8. Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Angers, France

    Corentin Orvain

  9. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA

    Roland B. Walter

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  1. Megan Othus
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  2. Domitilla Baccon
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  10. Roland B. Walter
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Contributions

MO conceptualized and designed this study, conducted all statistical analyses, and participated in data interpretation and drafting of the manuscript. DB, NA, ER-A, CO, CD, and RSB contributed to the collection and assembly of data. FM and BMS contributed to the provision of study material, patient recruitment, and acquisition of data. RBW conceptualized and designed this study, contributed to the collection and assembly of data, and participated in data analysis and interpretation and drafting of the manuscript. All authors revised the manuscript critically and gave final approval to submit for publication.

Corresponding author

Correspondence to Roland B. Walter.

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Othus, M., Baccon, D., Ali, N. et al. Relationship between morphologic remission with or without hematologic recovery and outcome after allogeneic hematopoietic cell transplantation in adult acute myeloid leukemia. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02407-y

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