Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment option for older patients with acute myeloid leukemia (AML) in second complete remission (CR2), particularly for those with favorable or intermediate cytogenetic risk, according to researchers who studied 169 transplants at 78 centers.
Median age of patients was 64 years (range, 60-78), and 71% had a Karnofsky performance status ≥90 at the time of transplant.
Three-year overall survival (OS) in the study was 42% (95% CI, 35%-49%), and leukemia-free survival was 37%. A multivariate analysis found that cytogenetic risk was the only independent risk factor for OS (p=0.023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics.
Multivariate analysis showed that cytogenetic risk was also an independent prognostic factor (p=0.01) for risk of relapse, with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics.
The researchers concluded that older patients with favorable and intermediate cytogenetic risk who achieve CR2 may benefit from HCT, and that “these patients may potentially benefit from novel post-transplant interventions aimed predominantly at reducing the risk of relapse.”