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Acute Leukemia

Patient age, remission status and HCT-CI in a combined score are prognostic for patients with AML undergoing allogeneic hematopoietic cell transplantation in CR1 and CR2

Bone Marrow Transplantation volume 50, pages 1405–1410 (2015)Cite this article

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Abstract

For AML, older age, advanced disease and increased hematopoietic cell transplant comorbidity index (HCT-CI) are associated with worse prognosis following allogeneic hematopoietic cell transplantation (HCT). This single-center retrospective study investigated the influence of pre-transplant characteristics on outcomes of 387 patients undergoing allogeneic HCT for AML in CR1 and CR2. The multivariable analysis model for overall survival (OS) included age (hazard ratio (HR)=2.24 for ages 31–64 years and HR=3.23 for age ⩾65 years compared with age ⩽30 years, P=0.003), remission status (HR=1.49 for CR2 compared with CR1, P=0.005) and HCT-CI score (HR=1.47 for ⩾3 compared with <3, P=0.005). Transplant year was significantly associated with OS (P=0.001) but this did not influence the model. A weighted score was developed with age ⩽30, CR1 and HCT-CI score <3 receiving 0 points each, and CR2 and HCT-CI score ⩾3 receiving 1 point each. Ages 31–64 received 2 points, age ⩾65 received 3 points. Scores were grouped as follows: scores 0–1 (low risk, n=36), score 2 (intermediate–low risk, n=147), score 3 (intermediate–high risk, n=141) and scores 4–5 (high risk, n=63) with 3-year OS of 71%, 55%, 42% and 29% for scores 0–1, 2, 3 and 4–5, respectively (P<0.0001). The score predicted nonrelapse mortality (P=0.03) but not cumulative incidence of relapse (P=0.18). This model should be validated for the pre-HCT assessment of AML patients in CR1 and CR2.

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

    F V Michelis, H A Messner, L McGillis, A Lambie, J Uhm, N Alam, M D Seftel, V Gupta, J Kuruvilla, J H Lipton & D D Kim

  2. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

    E G Atenafu

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  1. F V Michelis
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  2. H A Messner
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  3. E G Atenafu
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  4. L McGillis
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  5. A Lambie
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  6. J Uhm
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  7. N Alam
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  8. M D Seftel
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  9. V Gupta
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  10. J Kuruvilla
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  11. J H Lipton
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Correspondence to F V Michelis.

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Michelis, F., Messner, H., Atenafu, E. et al. Patient age, remission status and HCT-CI in a combined score are prognostic for patients with AML undergoing allogeneic hematopoietic cell transplantation in CR1 and CR2. Bone Marrow Transplant 50, 1405–1410 (2015). https://doi.org/10.1038/bmt.2015.165

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  • DOI: https://doi.org/10.1038/bmt.2015.165

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