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Acute myeloid leukemia

Prognostic index for patients with relapsed or refractory acute myeloid leukemia who underwent hematopoietic cell transplantation: a KSGCT multicenter analysis

Leukemia volume 33, pages 2610–2618 (2019)Cite this article

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Abstract

A multicenter retrospective study was performed to explore a prognostic scoring index in order to identify a population who are least likely to benefit from allogeneic hematopoietic cell transplantation (HCT) in patients with relapsed or refractory acute myeloid leukemia (AML). The cohort included 519 patients with AML, who received HCT between 2005 and 2015 at a status of relapse or primary induction failure. Multivariate analysis demonstrated five independent predictors for OS, including C-reactive protein ≥ 1 mg/dL, peripheral blood blast fraction ≥ 20%, poor-risk karyotype, performance status ≥ 2, and bone marrow unrelated donor as a stem cell source. A prognostic scoring index was explored based on these predictors, and successfully separated the cohort into four groups. At 2 years, OS was 47%, 24%, 8%, and 0% for Good (Score 0, 1: n = 118), Intermediate-1 (Score 2: n = 75), Intermediate-2 (Score 3: n = 39), and Poor (Score 4: n = 24), respectively (P < 0.001). The predicting value of the index was confirmed in a validation cohort. Although a further validation study is warranted, the scoring index may be useful to predict survival and to identify the population with the lowest survival prior to HCT in patients with relapsed or refractory AML.

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Acknowledgements

We would like to thank all members of KSGCT and Toyohiro Kawano, Aya Nozaki, and Eri Katou, members of the data center.

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Authors and Affiliations

  1. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    Takayoshi Tachibana, Masatsugu Tanaka & Heiwa Kanamori

  2. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Junya Kanda, Shun-ichi Kimura & Yoshinobu Kanda

  3. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  4. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan

    Takuma Ishizaki

  5. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Yuho Najima & Noriko Doki

  6. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

    Shin-ichiro Fujiwara & Yoshinobu Kanda

  7. Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  8. Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Satoshi Takahashi

  9. Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

    Takeshi Saito

  10. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Takehiko Mori & Shinichiro Okamoto

  11. Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan

    Shin Fujisawa

  12. Department of Hematology, Chiba University Hospital, Chiba, Japan

    Emiko Sakaida

  13. Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan

    Kenji Matsumoto

  14. Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan

    Nobuyuki Aotsuka

  15. First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan

    Moritaka Goto

  16. Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

    Reiko Watanabe

  17. Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan

    Katsuhiro Shono

  18. Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan

    Kensuke Usuki

  19. Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan

    Nobuhiro Tsukada

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  1. Takayoshi Tachibana
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Kanto Study

Group for Cell Therapy (KSGCT)

Contributions

TT was the primary investigator, managed the study, performed biomedical statistics, and wrote the paper. JK, TI, and YK contributed to managing and supporting the study as a working member of the group. YN, MT, ND, S Fujiwara, SK, MO, ST, TS, TM, S Fujisawa, EM, KM, NA, MG, RW, KS, KU, and NT contributed to collecting research forms as a representative of the institution. SO supervised the study.

Corresponding author

Correspondence to Takayoshi Tachibana.

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Conflict of interest

Dr. Usuki reports grants and personal fees from MSD K.K., Sumitomo Dainippon Pharma, Pfizer Japan, and Celgene Corporation, grants from Astellas Pharma, Otsuka, Kyowa Kirin, GlaxoSmithKline K.K., Sanofi K.K., Shire Japan, SymBio Pharmaceuticals Limited, Daiichi Sankyo, Boehringer-Ingelheim Japan, and Janssen Pharmaceutical K.K., and personal fees from Novartis, Ono Pharmaceutical, Takeda Pharmaceuticals, Chugai Pharmaceutical, Nippon Shinyaku, and Mochida Pharmaceutical. The remaining authors declare that they have no conflict of interest.

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Tachibana, T., Kanda, J., Ishizaki, T. et al. Prognostic index for patients with relapsed or refractory acute myeloid leukemia who underwent hematopoietic cell transplantation: a KSGCT multicenter analysis. Leukemia 33, 2610–2618 (2019). https://doi.org/10.1038/s41375-019-0494-9

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