Amer Beitinjaneh, Nelson J. Chao, Jakob Passweg, Ajoy Dias, Nosha Farhadfar, Robert Peter Gale, Jong Wook Lee, Miguel Angel Diaz, Partow Kebriaei, Corey Cutler, Tim Prestidge, Taiga Nishihori, Neil Palmisiano, Reinhold Munker, Haydar Frangoul, Witold B. Rybka, Michael Byrne, Lohith Gowda, Hemant S. Murthy, Cesar O. Freytes, Mahmoud Aljurf, Hai-Lin Wang, Elihu H. Estey, Jane L. Liesveld, Rammurti T. Kamble, Sherif M. Badawy, Mohamed A. Kharfan-Dabaja, Christopher G. Kanakry, Nasheed Hossain, Ankit Kansagra, Sunita Nathan, Kirk R. Schultz, Saurabh Chhabra, Kehinde Adekola, Richard F. Olsson, Siddhartha Ganguly, Hongtao Liu, David A. Rizzieri, Sachiko Seo, Leo F. Verdonck, Mark R. Litzow, O Ringdén, Mei-Jie Zhang, Brenda M. Sandmaier, Marjolein van der Poel, Joseph P. McGuirk, Daniel J. Weisdorf, Jean A. Yared, Marcos de Lima, Roger Strair, Vijaya Raj Bhatt, Mary Lynn Savoie, Richard J. Lin, Michael R. Grunwald, Paul Castillo, Mary Elizabeth Percival, Jean-Yves Cahn, Zachariah DeFilipp, Akshay Sharma, Melhem Solh, Maxwell M. Krem, Edward A. Copelan, Nelli Bejanyan, Hisham Abdel-Azim, Hillard M. Lazarus, Ulrike Bacher, Wael Saber, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Interne Geneeskunde, and MUMC+: MA Hematologie (9)
Acute myeloid leukemia (AML) patients often undergo allogeneic hematopoietic cell transplantation (alloHCT) in first complete remission (CR). We examined the effect of depth of clinical response, including incomplete count recovery (CRi) and/or measurable residual disease (MRD), in patients from the Center for International Blood and Marrow Transplantation Research (CIBMTR) registry. We identified 2492 adult patients (1799 CR and 693 CRi) who underwent alloHCT between January 1, 2007 and December 31, 2015. The primary outcome was overall survival (OS). Multivariable analysis was performed to adjust for patient-, disease-, and transplant-related factors. Baseline characteristics were similar. Patients in CRi compared to those in CR had an increased likelihood of death (HR: 1.27; 95% confidence interval: 1.13-1.43). Compared to CR, CRi was significantly associated with increased non-relapse mortality (NRM), shorter disease-free survival (DFS), and a trend toward increased relapse. Detectable MRD was associated with shorter OS, shorter DFS, higher NRM, and increased relapse compared to absence of MRD. The deleterious effects of CRi and MRD were independent. In this large CIBMTR cohort, survival outcomes differ among AML patients based on depth of CR and presence of MRD at the time of alloHCT. Further studies should focus on optimizing post-alloHCT outcomes for patients with responses less than CR.