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Acute Leukemias

Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission

Leukemia volume 29, pages 51–57 (2015)Cite this article

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Abstract

Non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (alloHSCT) can be predicted by the hematopoietic cell transplantation comorbidity index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score, which are composed of different parameters. We set out to integrate the parameters of both scores in patients with acute myeloid leukemia (AML) in first complete remission (CR1) receiving reduced intensity conditioning (RIC) alloHSCT. All parameters from the HCT-CI and the EBMT-score with the addition of patient and donor cytomegalovirus serology were evaluated in 812 patients by multivariable analysis with end-point NRM at 2 years. Subsequently, 16 parameters were selected based on hazard ratio >1.2, and were incorporated into a novel score, which was further internally validated by bootstrapping. Both the HCT-CI and the EBMT-score showed relatively weak predictive value, whereas the integrated score allowed to identify three clearly distinct risk groups with 2-year NRM estimates of 8±2% (low-risk), 17±2% (intermediate-risk) and 38±4% (high-risk), which also translated in prediction of overall survival. Collectively, integration of the most dominant parameters from the HCT-CI and the EBMT-score allowed to develop a simple and robust, integrated score with improved prediction of NRM for AML patients proceeding to RIC alloHSCT in CR1.

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Acknowledgements

Following EBMT publication rules, co-authorship was offered to centers contributing the highest number of patients. Nevertheless, the authors highly appreciate the contribution by many physicians and data managers throughout the EBMT, who made this analysis possible.

Authorship contributions

JV, ML, JJC and MM contributed to the study design. DN, GS, RFS, NM, AN, DB, VR, JJC and MM provided clinical data. ML was involved in performing statistical analysis. JV, ML, JJC and MM were involved in analyzing and interpreting the data and writing this report. All authors carefully reviewed and approved the final version of this report.

Author information

Author notes

  1. J J Cornelissen and M Mohty: These authors have shared senior authorship.

Authors and Affiliations

  1. Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands

    J Versluis & J J Cornelissen

  2. Sorbonne Universités, Paris, France

    M Labopin & M Mohty

  3. Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France,

    M Labopin, G Socie & M Mohty

  4. AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France

    M Labopin & M Mohty

  5. Department of Hematology and Oncology, University Leipzig, Leipzig, Germany

    D Niederwieser

  6. Department of Hematology/Transplantation, Hopital Saint-Louis, Sorbonne University, Paris, France

    G Socie

  7. Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany

    R F Schlenk

  8. Department of Hematology, CHU de Bordeaux, Bordeaux, France

    N Milpied

  9. Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    A Nagler

  10. Department of Hematology and Transplant Program, Institut Paoli Calmettes, Marseille, France

    D Blaise

  11. Eurocord International Registry, Hopital Saint Louis, Sorbonne University, Paris, France

    V Rocha

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  1. J Versluis
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  9. V Rocha
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  10. J J Cornelissen
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Corresponding author

Correspondence to J J Cornelissen.

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The authors declare no conflict of interest.

Additional information

Presented by the first author as an oral presentation at the 54th Annual Meeting of the American Society of Hematology, 8–11 December 2012, Atlanta, GA, USA; at the 7th Dutch Hematology Congress, 23– 25 January 2013, Arnhem, The Netherlands; and at the 40th Annual Meeting of the European Society of Blood and Marrow Transplantation, 30 March to 2 April 2014, Milan, Italy.

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Versluis, J., Labopin, M., Niederwieser, D. et al. Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission. Leukemia 29, 51–57 (2015). https://doi.org/10.1038/leu.2014.164

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