In newly diagnosed adults with acute myeloid leukemia (AML), early identification of high-risk cytogenetics and HLA testing with an organized effort to identify a suitable allogeneic hematopoietic cell transplant (HCT) donor can lead to a higher transplant rate and better transplant outcomes, according to research presented at ASH.
Research shows that although high-risk AML patients in first complete remission (CR1) who undergo HCT have better outcomes compared with those receiving consolidation chemotherapy, only 40% of such patients actually proceed to HCT.
This prospective study was designed to determine if an organized effort could rapidly identify alternative donors to improve the transplant rate in patients with high-risk AML in CR1. A secondary study endpoint was determining whether these efforts could lead to improved outcomes compared with the historical 2-year relapse-free survival (RFS) of 22%.
The study included adults age 18-60 years with untreated AML who were randomized to receive one of three types of induction therapy while concurrently undergoing cytogenetics testing to determine risk classification by NCCN guidelines. Of 738 eligible patients, 159 (22%) patients had high-risk cytogenetics and underwent expedited HLA typing. These patients were encouraged to obtain a transplant consultation with the goal of undergoing allogeneic HCT in CR1.
HCT was performed in 317 of 738 patients (43%) and 68 (64%) of the high-risk patients received a transplant in CR1 (p<0.001 compared to historical rate of 40%). Median time to HCT from CR1 was 76 days (range, 20-365). The 2-year RFS in the entire high-risk cohort was 32%, significantly higher than the 22% historical rate (p=0.05). Median RFS in the high-risk CR1 cohort (n=107) was 10 months. Median overall survival (OS) among all high-risk patients was 12 months (range, 1-33) and was 18 months (range, 3-33) for those transplanted in CR1.
In the oral presentation of the research abstract, lead author Dr. John Pagel of the Swedish Medical Center, Seattle, concluded that “early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplant rate of 64% in the high-risk group, which in turn led to a significant improvement in RFS over historical controls.”