Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study

Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is c...

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Autores: Rodríguez-Arbolí E, Martínez-Cuadrón D, Rodríguez-Veiga R, Carrillo-Cruz E, Gil-Cortés C, Serrano-López J, Bernal Del Castillo T, Martínez-Sánchez MDP, Rodríguez-Medina C, Vidriales B, Bergua JM, Benavente C, García-Boyero R, Herrera-Puente P, Algarra L, Sayas-Lloris MJ, Fernández R, Labrador J, Lavilla-Rubira E, Barrios-García M, Tormo M, Serrano-Maestro A, Sossa-Melo CL, García-Belmonte D, Vives S, Rodríguez-Gutiérrez JI, Albo-López C, Garrastazul-Sánchez MP, Colorado-Araujo M, Mariz J, Sanz MÁ, Pérez-Simón JA, Montesinos P, PETHEMA (Programa Español de Tratamientos en Hematología) and GETH (Grupo Españo
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p9370
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/9370
Access Level:acceso abierto
Palabra clave:Acute myeloid leukemia
Autologous stem cell transplant
Allogeneic stem cell transplant
Descripción
Sumario:Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P=.68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P<.001), as well as with increased nonrelapse mortality (P=.01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P=.02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P=.004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P=.004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

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