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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

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.

Author information

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.

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.

Correspondence to Takayoshi Tachibana.

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