Clinical features and prognostic nomogram for therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation

Therapy-related acute myeloid leukemia (t-AML), which develops after cytotoxic therapy, has a poorer prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential cure, its efficacy varies among patients. In this retrospective study, we analyzed 154 patients with t-AML who underwent hematopoietic stem cell transplantation (HSCT) at our institution to determine their clinical characteristics and develop a prognostic nomogram. The median ages at t-AML diagnosis prior disease diagnosis was 42 and 39 years, respectively. Multivariate analysis identified key prognostic indicators: leukocyte count at AML diagnosis ≥ 7 × 10ˆ9/L, genetic abnormalities before HSCT, platelet engraftment ≥ 28 days, age at prior disease ≥ 45 years, and relapse of prior disease. We developed a prognostic nomogram for LGPAR by categorizing patients into low, medium, and high-risk groups. The 3-year and 5-year overall survival (OS) rates for these groups were 92.6%, 84.4%, 14%, and 92.6%, 76.6%, and 7%, respectively. The 3-year and 5-year relapse-free survival (RFS) rates were 80%, 75.9%, 10.7% and 80%, 72.6%, and 10.7% for the respective risk groups. The 3-year and 5-year non-relapse mortality (NRM) rates were 0%, 5.6%, 63.3% and 0%, 9.3%, and 63.3% for these groups, respectively. This novel prognostic nomogram culminates in the development of a clinical decision-support tool for patients with t-AML undergoing allo-HSCT. • The new LGPAR nomogram can better predict outcomes for t-AML patients following HSCT • Delayed platelet engraftment is an important prognostic risk factor • Genetic abnormalities before HSCT connects to worse survival • Older age and recurrent of prior disease are independent risk factors • Early HSCT following gene negative and platelet engrafment may improve survival