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A novel risk model for predicting early relapse in acute myeloid leukemia patients undergoing allogeneic hematopoietic stem-cell transplantation

Bone Marrow Transplantation volume 58, pages 801–810 (2023)Cite this article

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Abstract

Relapse remains the leading cause of death in acute myeloid leukemia (AML) patients following allogeneic hematopoietic stem-cell transplantation (allo-HSCT), limiting the efficacy of allo-HSCT. Thus, the ability to identify high-risk patients in a manner that permits early intervention has the potential to improve survival outcomes. We retrospectively enrolled 414 younger patients (aged 14–60 years) with AML who received allo-HSCT between January 2014 and May 2020. From June 2020 to June 2021, 110 consecutive patients were included prospectively in the validation cohort. The primary outcome was early relapse (relapse within 1 year). The cumulative incidence of early relapse after allo-HSCT was 11.8%. The overall survival rate for patients who relapsed within 1-year was 4.1% at 3 years after relapse. After multivariable adjustment, statistically significant associations between primary resistance, pre-transplantation measurable residual disease, DNMT3A mutation, or white blood cell count at diagnosis and early relapse were observed. An early relapse prediction model was developed based on these factors and the model performed well. Patients deemed to have a high risk or a low risk of early relapse had early relapse rates of 26.2% and 6.8%, respectively (P < 0.001). The prediction model could be used to help identify patients at risk for early relapse and to guide personalized relapse prevention.

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Fig. 1: Cumulative incidence curves for early relapse according to different risk factors.
Fig. 2: Mutations of AML patients at the time of diagnosis.
Fig. 3: Cumulative incidence curves for early relapse according to different risk stratifications.
Fig. 4: Kaplan–Meier Curves of Survival outcomes for low-risk vs. high-risk group.

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Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request.

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Funding

This work was supported by grants from China National Natural Science Foundation (grants 82170205 and 81970097).

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Author notes

  1. These authors contributed equally: Xiao-Lin Yuan, Xiao-Yu Lai, Yi-Bo Wu, He Huang, Yi Luo.

Authors and Affiliations

  1. Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Xiao-Lin Yuan, Xiao-Yu Lai, Yi-Bo Wu, Lu-Xin Yang, Ji-Min Shi, Li-Zhen Liu, Jian Yu, Yan-Min Zhao, Wei-Yan Zheng, Jing-Song He, Jie Sun, Wen-Jun Wu, Yi Zhao, Yi-Shan Ye, Zhen Cai, He Huang & Yi Luo

  2. Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China

    Xiao-Lin Yuan, Xiao-Yu Lai, Yi-Bo Wu, Lu-Xin Yang, Ji-Min Shi, Li-Zhen Liu, Jian Yu, Yan-Min Zhao, Wei-Yan Zheng, Jing-Song He, Jie Sun, Wen-Jun Wu, Yi Zhao, Yi-Shan Ye, Zhen Cai, He Huang & Yi Luo

  3. Institute of Hematology, Zhejiang University, Hangzhou, China

    Xiao-Lin Yuan, Xiao-Yu Lai, Yi-Bo Wu, Lu-Xin Yang, Ji-Min Shi, Li-Zhen Liu, Jian Yu, Yan-Min Zhao, Wei-Yan Zheng, Jing-Song He, Jie Sun, Wen-Jun Wu, Yi Zhao, Yi-Shan Ye, Zhen Cai, He Huang & Yi Luo

  4. Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China

    Xiao-Lin Yuan, Xiao-Yu Lai, Yi-Bo Wu, Lu-Xin Yang, Ji-Min Shi, Li-Zhen Liu, Jian Yu, Yan-Min Zhao, Wei-Yan Zheng, Jing-Song He, Jie Sun, Wen-Jun Wu, Yi Zhao, Yi-Shan Ye, Zhen Cai, He Huang & Yi Luo

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  1. Xiao-Lin Yuan
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Contributions

X-LY: data collecting, analyzing data, writing of the original draft; X-YL: data collecting, analyzing data; Y-BW: analyzing data, discussing the results; HH: funding acquisition, project administration, and validation; YL: funding acquisition, project administration, analyzing data, review, and validation. All other authors discussed and interpreted the data and contributed to the final manuscript.

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Correspondence to He Huang or Yi Luo.

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Yuan, XL., Lai, XY., Wu, YB. et al. A novel risk model for predicting early relapse in acute myeloid leukemia patients undergoing allogeneic hematopoietic stem-cell transplantation. Bone Marrow Transplant 58, 801–810 (2023). https://doi.org/10.1038/s41409-023-01979-5

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