HCT curative for some older patients with AML

Allogeneic hematopoietic cell transplantation had a curative effect in some older patients with acute myeloid leukemia who were in their second complete remission, study data showed.

“The prognosis of patients with acute myeloid leukemia (AML) has improved significantly over the last two decades because of improvements in supportive care and the increasing use of allogeneic hematopoietic cell transplantation (HCT),” Fotios V. Michelis, MD, PhD, of the Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, and colleagues wrote. “Data on outcomes of patients undergoing HCT in their second complete remission are quite limited and are largely derived from case series including a minority of patients undergoing transplantation in second complete remission. For older patients in particular, some studies have demonstrated a lack of significant effect of patient age on outcomes.”

The researchers identified 196 patients (median age, 60  years) treated at 78 centers using the Center for International Blood and Marrow Transplant Research database and investigated outcomes for patients aged 60 years and older who underwent HCT for AML in their second complete remission.

Seventy-one percent of patients had a Karnofsky performance status of 90 or greater when they underwent HCT, and 159 patients (81%) received reduced-intensity condition regimens.

Univariate analysis showed a 3-year OS of 42% (95% CI, 35-49). The leukemia-free survival rate was 37% (95% CI, 30-44).

The cumulative incidence of nonrelapse mortality was 25% (95% CI, 19-32), and cumulative incidence of relapse was 38% (95% CI, 31-45). Cytogenetic risk was the only independent risk factor for OS, according to a multivariate analysis (HR = 1.14, 95% CI, 0.59-2.19 for intermediate-risk cytogenetics; HR = 2.32; 95% CI, 1.05-5.14 for unfavorable-risk cytogenetics).

“This study has demonstrated the potential for long-term remission with allogeneic HCT in select older patients with AML in second complete remission,” the researchers wrote. “However, patients with adverse cytogenetic risk derive a very limited benefit from transplantation despite achieving second complete remission.”

Based on their findings, the researchers suggest posttransplant interventions that focus on reducing relapse risk may benefit older patients in second complete remission.

“These patients should be offered thorough counseling concerning the risk of transplant-related morbidities and mortality,” the researchers wrote. – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.