Impact of pre-transplant disease burden on the outcome of allogeneic hematopoietic stem cell transplant in refractory and relapsed acute myeloid leukemia: a single-center study

Abstract

Patients with refractory or relapsed acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplant (HSCT) were retrospectively assessed to evaluate the effect of disease burden on outcomes and to identify predictive variables. Of all patients, 53 achieved a complete morphological remission (CR-AML) before transplant, while 48 failed to do so (NR-AML). In the CR-AML group, 32 patients displayed minimal residual disease (MRDpos). Estimated 5-year overall survival (5-OS) and disease-free survival of all patients was 37% and 29%, respectively. The 5-OS was significantly different between patients with CR-AML and NR-AML (46% vs. 18%). However, pre-transplant MRD status did not affect 5-OS (51% in MRDneg vs. 41% in MRDpos). Using multivariate analysis, we identified patient's physical condition and risk stratification as additional prognostic factors. Our findings suggest that NR status influences the outcomes of HSCT while pre-transplant MRD does not. HSCT needs to be optimized accordingly to treat high risk AML.

Keywords::

• Acute myeloid leukemia
• allogeneic hematopoietic stem cell transplant
• refractory
• relapse
• minimal residual disease

Acknowledgements

We thank Xiang Zhang and Tie-mei Song for data management. We thank every faculty member who has participated in these studies.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This work was supported by the National Natural Science Foundation of China (grant nos. 81270617 and 81300444), National High-tech R&D Program of China (863 Program) (grant no. 2012AA02A505) and National Public Health Grand Research Foundation (no. 201202017).