作者
Kamal Menghrajani,Alexandra Gomez-Arteaga,Rafael Madero-Marroquin,Mei-Jie Zhang,Khalid Bo-Subait,Jonathan L. Sanchez,Hailin Wang,Mahmoud Aljurf,Amer Assal,Ulrike Bacher,Sherif M. Badawy,Nelli Bejanyan,Vijaya Raj Bhatt,Christopher Bredeson,Michael Byrne,Paul Castillo,Jan Cerny,Saurabh Chhabra,Stefan O. Ciurea,Zachariah DeFilipp,Nosha Farhadfar,Shahinaz M. Gadalla,Robert Peter Gale,Siddhartha Ganguly,Lohith Gowda,Michael R. Grunwald,Shahrukh K. Hashmi,Gerhard C. Hildebrandt,Christopher G. Kanakry,Ankit Kansagra,Farhad Khimani,Maxwell M. Krem,Hillard M. Lazarus,Hongtao Liu,Rodrigo Martino,Fotios V. Michelis,Sunita Nathan,Taiga Nishihori,Richard F. Olsson,Ran Reshef,David A. Rizzieri,Jacob M. Rowe,Bipin N. Savani,Sachiko Seo,Akshay Sharma,Melhem Solh,Celalettin Ustun,Leo F. Verdonck,Christopher S. Hourigan,Brenda M. Sandmaier,Mark R. Litzow,Partow Kebriaei,Daniel J. Weisdorf,Yanming Zhang,Martin S. Tallman,Wael Saber
摘要
Abstract Little is known about whether risk classification at diagnosis predicts post-hematopoietic cell transplantation (HCT) outcomes in patients with acute myeloid leukemia (AML). We evaluated 8709 patients with AML from the CIBMTR database, and after selection and manual curation of the cytogenetics data, 3779 patients in first complete remission were included in the final analysis: 2384 with intermediate-risk, 969 with adverse-risk, and 426 with KMT2A-rearranged disease. An adjusted multivariable analysis detected an increased risk of relapse for patients with KMT2A-rearranged or adverse-risk AML as compared to those with intermediate-risk disease (hazards ratio [HR], 1.27; P = .01; HR, 1.71; P < .001, respectively). Leukemia-free survival was similar for patients with KMT2A rearrangement or adverse risk (HR, 1.26; P = .002, and HR, 1.47; P < .001), as was overall survival (HR, 1.32; P < .001, and HR, 1.45; P < .001). No differences in outcome were detected when patients were stratified by KMT2A fusion partner. This study is the largest conducted to date on post-HCT outcomes in AML, with manually curated cytogenetics used for risk stratification. Our work demonstrates that risk classification at diagnosis remains predictive of post-HCT outcomes in AML. It also highlights the critical need to develop novel treatment strategies for patients with KMT2A-rearranged and adverse-risk disease.