Personalized HCT Prognostic Risk Scores Identified for Children with Acute Leukemias

Researchers analyzed outcomes of children with acute myeloid (AML, n=790) and acute lymphoblastic leukemia (ALL, n=1,096) who survived for at least 1 year in remission after hematopoietic cell transplantation (HCT) have developed personalized long-term prognostic scoring systems for these patients.

Patient-, disease-, and transplant-related characteristics, plus prevalence of acute and chronic graft-versus-host disease (GVHD) were analyzed to develop risk scores for overall survival (OS) and leukemia-free survival (LFS).

The risk score for survival for AML includes age, disease status at transplantation, cytogenetic risk group and chronic GVHD. For ALL, the risk score includes age at transplantation and occurrence of chronic GVHD. Importantly, the researchers did not identify any prognostic factors beyond 4 years after transplantation for AML and beyond 3 years for ALL.

Additional adverse factors for children with AML included transplantation in relapse and intermediate- or poor-risk cytogenetics. The researchers noted that disease status at transplantation is potentially a modifiable factor and that early referral for transplantation consultation may therefore result in transplantation timing that is more beneficial to patients.

The 10-year probabilities of OS for AML based on good (score 0, 1, or 2), intermediate (score 3) and poor risk (score 4, 5, 6, or 7) were 94%, 87% and 68%, respectively. The 10-year probabilities of OS for ALL were 89% and 80% for good (score 0 or 1) and poor risk (score 2), respectively.

The researchers concluded that because recurrent leukemia and chronic GVHD were the predominant cause of late deaths, assigning a risk score based on 2-year LFS will help physicians to counsel patients and to develop appropriate long-term strategies to monitor the health of those patients at risk for late mortality.

Bitan M, et al. Biol Blood Marrow Transplant