Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation

Mary-Elizabeth Percival, Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. mperciva@seattlecca.org.
Hai-Lin Wang, CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Follow
Mei-Jie Zhang, CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Follow
Wael Saber, CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Marcos de Lima, Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
Mark Litzow, Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA.
Partow Kebriaei, Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Hisham Abdel-Azim, Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Kehinde Adekola, Division of Hematology and Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Mahmoud Aljurf, Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
Ulrike Bacher, Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Sherif M. Badawy, Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.Follow
Amer Beitinjaneh, University of Miami, Miami, FL, USA.Follow
Nelli Bejanyan, Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA.Follow
Vijaya Bhatt, The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.Follow
Michael Byrne, Vanderbilt University Medical Center, Nashville, TN, USA.
Jean-Yves Cahn, Department of Hematology, CHU Grenoble Alpes, Grenoble, France.Follow
Paul Castillo, UF Health Shands Children's Hospital, Gainesville, FL, USA.Follow
Nelson Chao, Department of Medicine, Division of Cell Therapy and Hematology, Duke University Medical Center, Durham, NC, USA.Follow
Saurabh Chhabra, CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Follow
Edward Copelan, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
Corey Cutler, Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Zachariah DeFilipp, Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA.Follow
Ajoy Dias, Beth Israel Deaconess Medical Center, Westwood, KS, USA.
Miguel Angel Diaz, Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
Elihu Estey, Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Nosha Farhadfar, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA.Follow
Haydar A. Frangoul, The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA.
César O. Freytes, Texas Transplant Institute, San Antonio, TX, USA.Follow
Robert Peter Gale, Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK.Follow
Siddhartha Ganguly, Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA.Follow
Lohith Gowda, Yale New Haven Hospital, New Haven, CT, USA.Follow
Michael Grunwald, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.

Abstract

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.

Publication Title

Bone marrow transplantation

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