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Allogeneic hematopoietic cell transplantation for patients with AML aged 70 years or older in first remission. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Bone Marrow Transplantation volume 58, pages 1033–1041 (2023)Cite this article

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Abstract

Accessibility to allogeneic hematopoietic cell transplantation (HCT) programs for older patients is growing constantly. We report on the clinical outcomes of a group of 701 adults aged ≥70 years, with acute myeloid leukemia (AML) in first complete remission (CR1), who received a first HCT, from HLA-matched sibling donors (MSD), 10/10 HLA-matched unrelated donors (UD), 9/10 HLA-mismatched unrelated donors (mUD) or haploidentical (Haplo) donors. The 2-year overall survival (OS) was 48.1%, leukemia-free survival (LFS) 45.3%, relapse incidence (RI) 25.2%, non-relapse mortality (NRM) 29.5% and GVHD-free, relapse-free survival (GRFS), 33.4%. Compared to MSD, patients transplanted from Haplo and UD presented lower RI (HR 0.46, 95% CI 0.25–0.8, p = 0.02 and HR 0.44, 95% CI: 0.28–0.69, p = 0.001, respectively); this translated into prolonged LFS for Haplo (HR 0.62, 95% CI: 0.39–0.99, p = 0.04). Patients transplanted from mUD exhibited the highest NRM incidence (HR 2.33, 95% CI: 1.26–4.31, p = 0.007). HCT in selected adult CR1 AML patients >70 years is feasible and could be associated with good clinical outcomes. Prospective clinical trials are warranted.

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Fig. 1: Transplant Outcomes according to donor.
Fig. 2: Graft-versus-Host disease.
Fig. 3: Grade ≥ 2 acute GvHD/relapse-free survival after trasplantation.

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Published data are available on specific request via email to the corresponding author.

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Author information

Authors and Affiliations

  1. IRCCS Azienda Ospedaliero-Universitaria di Bologna; Istituto “L. e A. Seràgnoli”, Bologna, Italy

    Enrico Maffini

  2. EBMT ALWP Statistical Unit, Saint Antoine Hospital, Sorbonne University, Paris, France

    Maud Ngoya & Jacques-Emmanuel Galimard

  3. Programme de Transplantation et Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France

    Samia Harbi

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

    Nicolaus Kröger

  5. Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany

    Uwe Platzbecker

  6. Bone Marrow Transplant Unit L 4043, National University Hospital Rigshospitalet, Copenhagen, Denmark

    Henrik Sengeloev

  7. Birmingham Centre for Cellular Therapy and Transplantation, Birmingham, UK

    Charles Craddock

  8. Department of Haematological Medicine, Kings College Hospital, King’s Denmark Hill Campus, London, UK

    Victoria Potter

  9. University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands

    Goda Choi

  10. Department d’Hematologie, CHU Nantes, Nantes, France

    Patrice Chevallier

  11. University Hospital Dresden, Medizinische Klinik und Poliklinik I, Dresden, TU Dresden, Germany

    Friedrich Stölzel

  12. Haematology Department, Manchester Royal Infirmary, Oxford Road, Manchester, UK

    Eleni Tholouli

  13. Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium

    Johan Maertens

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

    Fabio Ciceri

  15. Department of Haematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Jan Cornelissen

  16. Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Jaime Sanz

  17. Bone Marrow Transplantation Unit and Institute of Cellular therapy, University of Patras, Patras, Greece

    Alexandros Spyridonidis

  18. Hematology Unit, Ravenna Public Hospital and Romagna Transplant Network, Ravenna, Italy

    Francesco Lanza

  19. Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Ramat-Gan, Israel

    Arnon Nagler

  20. Clinical Hematology and Cellular Therapy Department, Sorbonne University, Saint Antoine Hospital, INSERM UMRs 938, Paris, France

    Mohamad Mohty

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  1. Enrico Maffini
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EM analyzed the data and wrote the manuscript; MN contributed to the statistical analysis. AN and MM critically appraised the paper. All the Authors approved the final version of the manuscript.

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Correspondence to Enrico Maffini.

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Maffini, E., Ngoya, M., Galimard, JE. et al. Allogeneic hematopoietic cell transplantation for patients with AML aged 70 years or older in first remission. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 58, 1033–1041 (2023). https://doi.org/10.1038/s41409-023-02027-y

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