Emerging prognostic factors identify older adults with high-risk AML likely to benefit from HCT

As allogeneic hematopoietic cell transplants (HCT) are becoming an increasingly common treatment option for older adults with acute myeloid leukemia (AML), a recent study identified prognostic factors that can be used to identify patients most likely to benefit from the treatment.

Researchers analyzed HCT outcomes in 185 people (>65 years old) with high-risk AML to identify predictive variables for outcomes. Overall survival (OS) at 2 and 5 years was 37.3% (CI=30.4-44.8) and 28.2% (CI=18.5-31.0) respectively, with similar outcomes reported for patients receiving a graft from a fully matched sibling or 10/10 matched unrelated donor. 

A multivariate analysis revealed the strongest independent risk factor for overall survival and relapse was associated with achievement of measurable residual disease (MRD) negative status prior to HCT. Results revealed excellent outcomes for 57 patients who were MRD negative and had few other negative prognostic factors (2-year OS=76%).

Additional independent predictors of poor OS included lack of hematologic recovery prior to HCT, high-risk genetics, multiple human leukocyte antigen mismatches, cardiovascular disease history and a major medical complication. For 58 patients who had detectable leukemia along with two or more additional predictive variables, 2-year survival outcomes were 8%.

The researchers concluded, “These data indicate the possibility to identify persons >65 years with high-risk AML likely to benefit from an allo transplant.”

Veltri L, et al. Bio Blood Marrow Transplant