Faculty Collaboration Database

Comparison of outcomes of HCT in blast phase of BCR-ABL1- MPN with de novo AML and with AML following MDS. Blood Adv 2020 Oct 13;4(19):4748-4757

Date

10/03/2020

Pubmed ID

33007075

Pubmed Central ID

PMC7556156

DOI

10.1182/bloodadvances.2020002621

Scopus ID

2-s2.0-85092401454 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

Comparative outcomes of allogeneic hematopoietic cell transplantation (HCT) for BCR-ABL1- myeloproliferative neoplasms (MPNs) in blast phase (MPN-BP) vs de novo acute myeloid leukemia (AML), and AML with prior myelodysplastic syndromes (MDSs; post-MDS AML), are unknown. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared HCT outcomes in 177 MPN-BP patients with 4749 patients with de novo AML, and 1104 patients with post-MDS AML, using multivariate regression analysis in 2 separate comparisons. In a multivariate Cox model, no difference in overall survival (OS) or relapse was observed in patients with MPN-BP vs de novo AML with active leukemia at HCT. Patients with MPN-BP in remission had inferior OS in comparison with de novo AML in remission (hazard ratio [HR], 1.40 [95% confidence interval [CI], 1.12-1.76]) due to higher relapse rate (HR, 2.18 [95% CI, 1.69-2.80]). MPN-BP patients had inferior OS (HR, 1.19 [95% CI, 1.00-1.43]) and increased relapse (HR, 1.60 [95% CI, 1.31-1.96]) compared with post-MDS AML. Poor-risk cytogenetics were associated with increased relapse in both comparisons. Peripheral blood grafts were associated with decreased relapse in MPN-BP and post-MDS AML (HR, 0.70 [95% CI, 0.57-0.86]). Nonrelapse mortality (NRM) was similar between MPN-BP vs de novo AML, and MPN-BP vs post-MDS AML. Total-body irradiation-based myeloablative conditioning was associated with higher NRM in both comparisons. Survival of MPN-BP after HCT is inferior to de novo AML in remission and post-MDS AML due to increased relapse. Relapse-prevention strategies are required to optimize HCT outcomes in MPN-BP.

Author List

Gupta V, Kim S, Hu ZH, Liu Y, Aljurf M, Bacher U, Beitinjaneh A, Cahn JY, Cerny J, Copelan E, Gadalla SM, Gale RP, Ganguly S, George B, Gerds AT, Gergis U, Hamilton BK, Hashmi S, Hildebrandt GC, Kamble RT, Kindwall-Keller T, Lazarus HM, Liesveld JL, Litzow M, Maziarz RT, Nishihori T, Olsson RF, Rizzieri D, Savani BN, Seo S, Solh M, Szer J, Verdonck LF, Wirk B, Woolfrey A, Yared JA, Alyea EP, Popat UR, Sobecks RM, Scott BL, Nakamura R, Saber W

Authors

Soyoung Kim PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blast Crisis
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
Transplantation Conditioning
Transplantation, Homologous