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Time to transplantation and pediatric acute myeloid leukemia outcomes

Bone Marrow Transplantation volume 58, pages 343–345 (2023)Cite this article

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Acute myeloid leukemia (AML) encompasses 15–20% of childhood leukemias, yet continues to cause disproportionate mortality [1]. To combat this, patients with high risk features are consolidated with allogeneic hematopoietic cell transplant (allo-HCT) in first complete remission (CR1) while others receive allo-HCT following relapse (CR2), but only 60–70% of patients are alive and in remission after transplant [2]. Current treatment for newly diagnosed pediatric AML patients traditionally involves two intensive induction courses followed by post-remission intensification chemotherapy. This approach is largely empiric and based on historic outcomes at a time when risk stratification and disease assessments were limited, and thus has evolved with some centers proceeding more quickly to allo-HCT.

Limited studies in adult AML patients suggest that longer time to transplant (TTT) worsens outcomes [3,4,5], while in pediatric AML patients TTT effect on outcomes is entirely lacking. Based on the available adult data, we hypothesized that longer TTT would correlate with worse transplant outcomes for pediatric patients with AML. To investigate our hypothesis, data from the Center for International Blood & Marrow Transplant Research datasets for secondary analysis was used [6]. This dataset contains patient and disease characteristics as well as TTT. Patients with AML and less than 18 years old who received a first allo-HCT between 2008 and 2017 in the United States were included in this analysis.

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Fig. 1: Survival stratified by time to transplant (TTT).

Data availability

The datasets generated during and/or analysed during the current study are available in the CIBMTR repository, https://www.cibmtr.org/ReferenceCenter/PubList/PubDsDownload/Pages/default.aspx.

References

  1. Creutzig U, Kutny MA, Barr R, Schlenk RF, Ribeiro RC. Acute myelogenous leukemia in adolescents and young adults. Pediatr Blood Cancer. 2018;65:e27089.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Elgarten CW, Aplenc R. Pediatric acute myeloid leukemia: updates on biology, risk stratification, and therapy. Curr Opin Pediatr. 2020;32:57–66.

    Article  PubMed  Google Scholar 

  3. Zhu Y, Gao Q, Du J, Hu J, Liu X, Zhang F. Effects of post-remission chemotherapy before allo-HSCT for acute myeloid leukemia during first complete remission: a meta-analysis. Ann Hematol. 2018;97:1519–26.

    Article  CAS  PubMed  Google Scholar 

  4. Lim SJ, Lim MJ, Raptis A, Hou JZ, Farah R, Marks SM, et al. Inferior outcome after allogeneic transplant in first remission in high-risk AML patients who required more than two cycles of induction therapy. Am J Hematol. 2015;90:715–8.

    Article  CAS  PubMed  Google Scholar 

  5. Jourdan E, Maraninchi D, Reiffers J, Gluckman E, Rio B, Jouet JP, et al. Early allogeneic transplantation favorably influences the outcome of adult patients suffering from acute myeloid leukemia. Societe Francaise de Greffe de Moelle (SFGM). Bone Marrow Transpl. 1997;19:875–81.

    Article  CAS  Google Scholar 

  6. Qayed M, Ahn KW, Kitko CL, Johnson MH, Shah NN, Dvorak C, et al. A validated pediatric disease risk index for allogeneic hematopoietic cell transplantation. Blood. 2021;137:983–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gilleece MH, Labopin M, Yakoub-Agha I, Volin L, Socie G, Ljungman P, et al. Measurable residual disease, conditioning regimen intensity, and age predict outcome of allogeneic hematopoietic cell transplantation for acute myeloid leukemia in first remission: A registry analysis of 2292 patients by the Acute Leukemia Working Party European Society of Blood and Marrow Transplantation. Am J Hematol. 2018;93:1142–52.

    Article  PubMed  Google Scholar 

  8. Percival ME, Wang HL, Zhang MJ, Saber W, de Lima M, Litzow M, et al. Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transpl. 2021;56:2108–17.

    Article  CAS  Google Scholar 

  9. Oran B, Jorgensen JL, Marin D, Wang S, Ahmed S, Alousi AM, et al. Pre-transplantation minimal residual disease with cytogenetic and molecular diagnostic features improves risk stratification in acute myeloid leukemia. Haematologica. 2017;102:110–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lamble A, Phelan R, Burke M. When less is good, is none better? the prognostic and therapeutic significance of peri-transplant minimal residual disease assessment in pediatric acute lymphoblastic leukemia. J Clin Med. 2017;6.

  11. Xue YJ, Cheng YF, Lu AD, Wang Y, Zuo YX, Yan CH, et al. Efficacy of haploidentical hematopoietic stem cell transplantation compared with chemotherapy as postremission treatment of children with intermediate-risk acute myeloid leukemia in first complete remission. Clin Lymphoma Myeloma Leuk. 2021;21:e126–e36.

    Article  CAS  PubMed  Google Scholar 

  12. Rashidi A, Linden MA, DeFor TE, Warlick E, Bejanyan N, Yohe S, et al. History of consolidation is prognostic in acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation in minimal residual disease-negative first complete remission. Am J Hematol. 2017;92:1032–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The Center for International Blood and Marrow Transplant and Research (CIBMTR) is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Institutes of Health, National Cancer Institute (NCI), National Heart, Lung and Blood Institute (NHLBI), and National Institute of Allergy and Infectious Diseases (NIAID), and contract HHSH250201200016C with the Health Resources and Services Administration/Department Health and Human Services (HRSA/DHHS). The views expressed in this article are that of the authors and does not reflect the position of the Center for International Blood and Marrow Transplant Research or the official policy or position of the National Institutes of Health, Health Resources and Services Administration, or any other agency of the US Government.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Hematology/Oncology/BMT, University of Colorado School of Medicine, Aurora, CO, USA

    Lindsey A. Murphy, Kristen Miller, Amanda C. Winters, Anna R. K. Franklin, Michael R. Verneris & Amy K. Keating

  2. Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, CO, USA

    Lindsey A. Murphy, Amanda C. Winters, Anna R. K. Franklin, Michael R. Verneris & Amy K. Keating

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  1. Lindsey A. Murphy
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Contributions

LM, MV, and AK.performed study concept/design and manuscript preparation; KM performed statistical analysis and development of methodology. All authors participated in the analytical component of this work. AW and AF provided expertise and support in designing study question and data analysis. All authors participated in review and revision of the paper.

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Correspondence to Amy K. Keating.

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Murphy, L.A., Miller, K., Winters, A.C. et al. Time to transplantation and pediatric acute myeloid leukemia outcomes. Bone Marrow Transplant 58, 343–345 (2023). https://doi.org/10.1038/s41409-022-01893-2

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