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 Eu

Date publication

juillet 2018

Journal

American journal of hematology

Auteurs

Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric

Tous les auteurs :
Gilleece MH, Labopin M, Yakoub-Agha I, Volin L, Socié G, Ljungman P, Huynh A, Deconinck E, Wu D, Bourhis JH, Cahn JY, Polge E, Mohty M, Savani BN, Nagler A

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/29981272

Résumé

Patients with acute myeloid leukemia (AML) in morphological first complete remission (CR1) pre-allogeneic hematopoietic cell transplantation (HCT) may have measurable residual disease (MRD) by molecular and immunophenotyping criteria. We assessed interactions of MRD status with HCT conditioning regimen intensity in patients aged <50 years (y) or ≥50y. This was a retrospective study by the European Society for Blood and Marrow Transplantation registry. Patients were >18y with AML CR1 MRD NEG/POS and recipients of HCT in 2000-2015. Conditioning regimens were myeloablative (MAC), reduced intensity (RIC) or non-myeloablative (NMA). Outcomes included leukemia free survival (LFS), overall survival (OS), relapse incidence (RI), non-relapse mortality (NRM), chronic graft-versus-host (cGVHD) and GVHD-free and relapse-free survival (GRFS). The 2292 eligible patients were categorized into 4 paired groups: <50y MRD POS MAC (N=240) vs RIC/NMA (N=58); <50y MRD NEG MAC (N=665) vs RIC/NMA (N=195); ≥50y MRD POS MAC (N=126) vs RIC/NMA (N=230) & ≥50y MRD NEG MAC (N=223) vs RIC/NMA (N=555). In multivariate analysis RIC/NMA was only inferior to MAC for patients in the <50y MRD POS group, with worse RI (HR 1.71) & LFS (HR 1.554). Patients <50Y MRD NEG had less cGVHD after RIC/NMA HCT (HR 0.714). GRFS was not significantly affected by conditioning intensity in any group. Patients aged <50y with AML CR1 MRD POS status should preferentially be offered MAC allo-HCT. Prospective studies are needed to address whether patients with AML CR1 MRD NEG may be spared the toxicity of MAC regimens. New approaches are needed for ≥50y AML CR1 MRD POS. This article is protected by copyright. All rights reserved.

Référence

Am. J. Hematol.. 2018 Jul 7;: