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Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia

Bone Marrow Transplantation volume 56, pages 387–394 (2021)Cite this article

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Abstract

The aim of this study was to develop a comprehensive system for predicting non-relapse mortality after allogeneic hematopoietic cell transplantation (HCT) during first complete remission (CR) of acute myeloid leukemia (AML). After dividing 2344 eligible patients randomly into a training set and a validation set, we first identified and scored five parameters, that is, age, sex, performance status, HCT-comorbidity index (HCT-CI), and donor type, on the basis of their impact on non-relapse mortality for patients in the training set. The non-relapse mortality-J (NRM-J) index using the sum of these scores was then applied to patients in the validation set, resulting in a clear differentiation of non-relapse mortality, with expected 2-year rates of 11%, 16%, 27%, and 33%, respectively (P < 0.001). The estimated c-statistic was 0.67, which was significantly higher than that of the European Society for Blood and Marrow Transplantation score (0.60, P = 0.002) and the HCT-CI (0.57, P < 0.001). The NRM-J index showed a significant association with overall survival, but not with relapse. Our findings demonstrate that the NRM-J index is useful for predicting post-transplant non-relapse mortality for patients with AML in first CR, for whom the decision of whether to perform allogeneic HCT is critical.

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Fig. 1: Cumulative incidences of non-relapse mortality based on the sum of points assigned to patients in the training set.
Fig. 2: Cumulative incidences of non-relapse mortality based on the NRM-J index for patients in the validation set.
Fig. 3: Kaplan–Meier estimates of overall survival based on the NRM-J index for patients in the validation set.

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Acknowledgements

This work was supported in part by 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 (AMED), grant number: 18ek0510023h0002, and a grant from the Aichi Cancer Research Foundation, grant number: 2019–8.

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Authors and Affiliations

  1. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

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

    Takaaki Konuma

  3. Aichi Medical University, Nagakute, Japan

    Shohei Mizuno

  4. Oita Prefectural Hospital, Oita, Japan

    Masuho Saburi

  5. Tokyo Women’s Medical University, Tokyo, Japan

    Akihito Shinohara

  6. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

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

    Atsushi Marumo

  8. Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  9. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  10. Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  11. Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

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

    Satoshi Yoshioka

  13. Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hirohisa Nakamae

  14. Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tadakazu Kondo & Junya Kanda

  15. Japanese Red Cross Kinki Block Blood Center, Osaka, Japan

    Takafumi Kimura

  16. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

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

    Yoshiko Atsuta

  18. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  19. Jichi Medical University Saitama Medical Center, Saitama, Japan

    Hideki Nakasone

  20. The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

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  1. Masamitsu Yanada
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Correspondence to Masamitsu Yanada.

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Yanada, M., Konuma, T., Mizuno, S. et al. Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia. Bone Marrow Transplant 56, 387–394 (2021). https://doi.org/10.1038/s41409-020-01032-9

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