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Stem cell transplantation

Complete remission with incomplete count recovery (CRi) prior to allogeneic HCT for acute myeloid leukaemia is associated with a high non-relapse mortality

Leukemia volume 34, pages 667–670 (2020)Cite this article

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Consolidation of chemotherapy with allogeneic haematopoietic cell transplantation (HCT) improves outcome in a large proportion of patients with acute myeloid leukaemia (AML) by reducing relapse risk and improving survival [1]. Disease response is a powerful predictor of outcome, and is incorporated into standard risk stratification models such as the EBMT score [2]. However, it is becoming increasingly clear that the group of patients categorised as complete remission (CR) encompasses a heterogenous population. The European LeukemiaNET (ELN)-2017 response criteria recognise this, and permits further sub-classification of CR patients into CRMDR- for those with undetectable measurable residual disease (MRD), as well as CRi for those in remission but with incomplete haematologic recovery [3]. The impact of MRD in AML is established [4, 5] and its impact on HCT outcome has recently been shown [6, 7], however, the impact of incomplete count recovery is less clear, and unknown in the setting of HCT. We therefore compared the outcomes of patients undergoing HCT for AML in CR to those in CRi and active disease (AD).

This single centre retrospective observational study included all patients undergoing HCT for AML at our institution from January 2005 until December 2017. All patients gave informed consent for data collection and use for research in line with the declaration of Helsinki. All patients met the WHO criteria for AML [8] and had received induction chemotherapy, either in line with the UK-NCRI AML study protocols or by physician choice of institutionally approved regimens (most commonly 2 cycles of daunorubicin and cytarabine-based regimens with or without consolidation with high dose cytarabine based regimens).

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Acknowledgements

We thank M. Robinson for thoughtful discussion and formatting support. We also acknowledge the work of Sandra Loaiza, head of operations at the John Goldman Stem Cell Facility and David Slade, data manager at Imperial College Healthcare NHS Trust. AJI is supported by a National Institute for Health Research (NIHR) Clinical Lectureship, and AJI and JFA acknowledges support from the NIHR and Imperial Biomedical Research Centre (BRC).

Author contributions

AJI, JP and RS conceived, designed, performed the research and wrote the manuscript. PW, SL, FF and DB collected and collated data, and AJI and RS performed statistical analysis. PCM, ENM and EYF performed MRD analysis. RP, DM, EO and JFA provided guidance on the research strategy. All authors reviewed and edited the manuscript.

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Authors and Affiliations

  1. Centre for Haematology, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK

    Andrew J. Innes, Philippa Woolley, Sara Lozano, Fiona Fernando, Divya Bansal, Renuka Palanicawandar, Dragana Milojkovic, Philippa C. May, Elisabet Nadal-Melsio, Eva Yebra-Fernandez, Eduardo Olavarria & Jane F. Apperley

  2. Department of Haematology, Imperial College Healthcare NHS Trust, London, W12 0HS, UK

    Andrew J. Innes, Richard M. Szydlo, Renuka Palanicawandar, Dragana Milojkovic, Philippa C. May, Elisabet Nadal-Melsio, Eva Yebra-Fernandez, Eduardo Olavarria, Jane F. Apperley & Jiří Pavlů

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  1. Andrew J. Innes
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Correspondence to Jiří Pavlů.

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Innes, A.J., Woolley, P., Szydlo, R.M. et al. Complete remission with incomplete count recovery (CRi) prior to allogeneic HCT for acute myeloid leukaemia is associated with a high non-relapse mortality. Leukemia 34, 667–670 (2020). https://doi.org/10.1038/s41375-019-0572-z

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