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ACUTE MYELOID LEUKEMIA

Allogeneic hematopoietic cell transplantation for patients with acute myeloid leukemia not in remission

Leukemia volume 38, pages 513–520 (2024)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the last option for long-term survival for patients with chemotherapy-refractory acute myeloid leukemia (AML). By using the Japanese nationwide registry data, we analyzed 6927 adults with AML having undergone first allogeneic HCT while not in complete remission (CR) between 2001 and 2020. The 5-year overall survival (OS), relapse, and non-relapse mortality (NRM) rates were 23%, 53%, and 27%, respectively. Multivariate analysis identified several factors predictive of OS mainly through their effects on relapse (cytogenetics, percentage of blasts in the peripheral blood, and transplantation year) and NRM (age, sex, and performance status). As regards disease status, relapsed disease was associated with a higher risk of overall mortality than primary induction failure (PIF). The shorter duration of the first CR increased the risks of relapse and overall mortality for the relapsed group, and the longer time from diagnosis to transplantation did so for the PIF group. Our experience compiled over the past two decades demonstrated that >20% of patients still enjoy long-term survival with allogeneic HCT performed during non-CR and identified those less likely to benefit from allogeneic HCT. Future efforts are needed to reduce the risk of posttransplant relapse in these patients.

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Fig. 1: Outcomes after transplantation.
Fig. 2: Kaplan–Meier estimates of overall survival for subgroups.
Fig. 3: Kaplan–Meier estimates of overall survival for patients with relapsed disease.

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Data availability

The data of this study are not publicly available in general due to ethical restrictions that it exceeds the scope of the recipient/donor’s consent for research use in the registry. However, the data may be available from the corresponding author upon reasonable request and with permission of the JSTCT/JDCHCT.

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Acknowledgements

This work was supported in part by a grant from the Aichi Cancer Research Foundation (grant number: 2023-1-7) (MY), and a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (grant number: 19ek0510023h0003) (YA).

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Authors and Affiliations

  1. Nagoya City University East Medical Center, Nagoya, Japan

    Masamitsu Yanada

  2. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

  3. Kyusyu University Beppu Hospital, Beppu, Japan

    Satoshi Yamasaki

  4. Kobe City Medical Center General Hospital, Kobe, Japan

    Tadakazu Kondo

  5. Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

    Takahito Kawata

  6. Tokai University School of Medicine, Isehara, Japan

    Kaito Harada & Makoto Onizuka

  7. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  8. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  9. Hyogo Medical University Hospital, Nishinomiya, Japan

    Satoshi Yoshihara

  10. Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  11. Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  12. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  13. Saiseikai Maebashi Hospital, Maebashi, Japan

    Satoru Takada

  14. National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  15. Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Tetsuya Nishida

  16. Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  17. Kindai University Hospital, Osaka-, Sayama, Japan

    Kentaro Serizawa

  18. Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  19. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  20. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  21. Aichi Medical University, Nagakute, Japan

    Yoshiko Atsuta

  22. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

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  1. Masamitsu Yanada
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  2. Satoshi Yamasaki
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Contributions

MY designed the study, analyzed data, interpreted the results, and drafted the paper; SY, TK, TK, KH, NU, ND, SY, YK, TE, MT, ST, TK, TN, SO, KS, and TK interpreted results and revised the paper; MO, YK, TF, and YA contributed to data management, interpreted the results, and revised the paper; and all authors approved the final version of the paper.

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Correspondence to Masamitsu Yanada.

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Yanada, M., Yamasaki, S., Kondo, T. et al. Allogeneic hematopoietic cell transplantation for patients with acute myeloid leukemia not in remission. Leukemia 38, 513–520 (2024). https://doi.org/10.1038/s41375-023-02119-0

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