Allogeneic transplantation in acute myelogenous leukemia: a comprehensive single institution's experience

Abstract

Since decades, debates on the role and timing of allogeneic transplantation HSCT in acute myelogenous leukemia (AML) persist. Time to transplant introduces an immortal time and current treatment algorithm mainly relies on the ELN’s disease risk classification. Previous studies are also limited to age groups, remission status and other ill-defined parameters. We studied all patients at diagnosis irrespective of age and comorbidities to estimate the cumulative incidence and potential benefit or disadvantage of HSCT in a single center. As a time-dependent covariate, HSCT improved overall survival in intermediate and poor risk patients (hazard ratio 0.51; p=0.004). In good risk patients only 8 were transplanted in first complete remission. Overall, the 4-year cumulative incidence of HSCT was only 21.9% but was higher (52.1%) for patients in the first age quartile (16-57) and 26.4% in older patients (57-70); p<0.001). It was negligible in patients older than 70 years reflecting our own transplant policy but also barriers to transplantation (comorbidities and remission status). However, HSCT patients need to survive, be considered eligible both by the referring and the HSCT physicians and have a suitable donor to get transplantation. We thus comprehensively analyzed the complete decision-making and outcome of all our AML patients from diagnosis to last follow-up to decipher how patient allocation and therapy inform the value of HSCT. The role of HSCT in AML is moving and broad access to different donors including haploidentical. Thus, it may (or may not) lead to increased numbers of allogeneic HSCT in AML in adults.