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Impact of disease burden on clinical outcomes of AML patients receiving allogeneic hematopoietic cell transplantation: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Bone Marrow Transplantation volume 58, pages 784–790 (2023)Cite this article

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Abstract

Pre-transplant detectable measurable residual disease (MRD) is still associated with high risk of relapse and poor outcomes in acute myeloid leukemia (AML). We aimed at evaluating the impact of disease burden on prediction of relapse and survival in patients receiving allogeneic hematopoietic cell transplantation (allo-HCT) in first remission (CR1). We identified a total of 3202 adult AML patients, of these 1776 patients were in CR1 and MRD positive and 1426 patients were primary refractory at time of transplant. After a median follow-up of 24.4 months, non-relapse mortality and relapse rate were significantly higher in the primary refractory group compared to the CR1 MRD positive group (Hazards Ratio (HR) = 1.82 (95% CI: 1.47–2.24) p < 0.001 and HR = 1.54 (95% CI: 1.34–1.77), p < 0.001), respectively. Leukemia-free survival (LFS) and overall survival (OS) were significantly worse in the primary refractory group (HR = 1.61 (95% CI: 1.44-1.81), p < 0.001 and HR = 1.71 (95% CI: 1.51–1.94), p < 0.001, respectively). Our real-life data suggest that patients in CR1 and MRD positive at time of transplant could still be salvaged by allo-HCT with a 2-year OS of 63%, if negative MRD cannot be obtained and their outcomes are significantly better than patients transplanted with active disease.

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Fig. 1: Comparison of post-transplant outcomes between the two groups of complete remission with detectable measurable residual disease (CR1 MRD+) and primary refractory at time of transplant (Prim. Ref).

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Acknowledgements

We acknowledge all participating EBMT centers as well as the patients and their respective treating physicians that made this database accessible for research.

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Authors and Affiliations

  1. Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Iman Abou Dalle & Ali Bazarbachi

  2. Department of Haematology, Hopital Saint-Antoine, INSERM, Paris, France

    Myriam Labopin & Mohamad Mohty

  3. Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Nicolaus Kröger

  4. Dept. of Bone Marrow Transplantation, University Hospital, Essen, Germany

    Thomas Schroeder

  5. Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany

    Jürgen Finke

  6. Department of Medicine A/Hematology and Oncology, University of Muenster, Muenster, Germany

    Matthias Stelljes

  7. Klinik für Innere Medizin mit SP Hämatologie, Onkologie und Immunologie, Philipps-Universität, Marburg, Germany

    Andreas Neubauer

  8. Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  9. CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France

    Ibrahim Yakoub-Agha

  10. Department of Hematology, Helsinki University Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland

    Urpu Salmenniemi

  11. CHU Bordeaux, Service d’hématologie Clinique et Thérapie Cellulaire, 33000, Pessac, France

    Edouard Forcade

  12. Department of Medicine, Turku University Central Hospital, PL 52, Turku, Finland

    Maija Itäla-Remes

  13. Department Medicine V, University of Heidelberg, Heidelberg, Germany

    Peter Dreger

  14. Department of Medicine II, University Hospital, Frankfurt, Germany

    Gesine Bug

  15. EBMT Activity Survey Office, Hematology Division, University Hospital, Basel, Switzerland

    Jakob Passweg

  16. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Michael Heuser

  17. Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Goda Choi

  18. Department of Hematology, Hospital Saint Antoine, Paris, France

    Eolia Brissot

  19. Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute, Oncology Center—Gliwice, Gliwice, Poland

    Sebastian Giebel

  20. Department of Bone Marrow Transplantation, Chaim Sheba Medical Center—Tel-Hashomer, Tel-Hashomer, Israel

    Arnon Nagler

  21. Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy

    Fabio Ciceri

Authors
  1. Iman Abou Dalle
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Contributions

IA and AB wrote the manuscript with input from the coauthors. ML performed the statistical analysis. IA, MM, and AB conceived and designed the study. MM and AB directed and edited the manuscript. All authors participated in the discussion, intellectual content, and have reviewed and approved the final version of the manuscript.

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Correspondence to Ali Bazarbachi.

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Abou Dalle, I., Labopin, M., Kröger, N. et al. Impact of disease burden on clinical outcomes of AML patients receiving allogeneic hematopoietic cell transplantation: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 58, 784–790 (2023). https://doi.org/10.1038/s41409-023-01961-1

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