Outcome and Risk Factors of Overall Survival for Acute Myeloid Leukemia Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation in First Complete Remission

Author(s): Haiyan Bao, Vijay Kumar Kolluri, Jia Chen, Xiao Ma, Yue Han, Chengcheng Fu, Yang Mei, Depei Wu

Objective: Acute myeloid leukemia (AML) is the most common acute leukemia in adults. To investigate how we can improve the efficacy of allogeneic hematopoietic stem cell transplantation (HSCT) for AML patients in first complete remission (CR1), we analyze the risk factors of overall survival (OS), and depict gene mutation profiles in the patients.

Materials and Methods: AML patients undergoing allogeneic HSCT in CR1 from January 2011 to January 2015 were retrospectively reviewed. We compared patients’ disease characteristics and survival outcomes between the survivor and non-survivor groups. The study cohort comprised of 135 AML patients.

Results: The OS for all patients was 63.7%. Gene mutations were commonly detected. The genes with mutation incidence > 10% include NRAS, ASXL1, TET2, IDH1/2, C-KIT, CEBPA biallelic, WT1, NPM1, DNMT3A, and FLT3-ITD. The risk factors found in univariate analysis were age, risk group at diagnosis, more than one course to achieve CR1, acute graft versus host disease (aGVHD) grade III-IV, without chronic graft versus host disease (cGVHD), relapse, and IDH1/2 mutation. Multivariate analysis further identified that aGVHD grade III-IV and relapse are independent risk factors of OS, whereas cGVHD is a favorable factor. IDH1/2 mutation may confer an adverse effect on allogeneic HSCT.

Conclusions: Our study suggests that allogeneic HSCT is a curative way for the majority of AML patients in CR1. New strategies to control severe aGVHD and relapse are emerging. Targeted therapy (e.g., IDH 1/2 inhibitors) and manipulation of immune system may contribute to an improved OS in these patients.