Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

Francesco Saraceni, Myriam Labopin, Edouard Forcade, Nicolaus Kröger, Gerard Socié, Riitta Niittyvuopio, Jan J. Cornelissen, Hélène Labussière-Wallet, Didier Blaise, Goda Choi, Jenny L. Byrne, Gaelle Guillerm, Tony Marchand, Jordi Esteve, Ali Bazarbachi, Bipin Savani, Attilio Olivieri, Arnon Nagler, Mohamad Mohty

Research output: Contribution to journalArticlepeer-review

Abstract

Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) with a reduced performance status. We herein present the results of a registry study on 2,936 AML patients undergoing allo-SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two-year leukemia-free survival (LFS), overall survival (OS) and graft-versus-host disease (GVHD)-free, and relapse-free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non-relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% (p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced-intensity conditioning (RIC) regimen was associated with an increased risk of relapse (p = 0.002) and lower GRFS (p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM (p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS (p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III-IV acute GVHD (p < 0.01) and NRM (p < 0.01) in comparison to other donor types. In conclusion, allo-SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment.

Original languageEnglish
Pages (from-to)23-33
Number of pages11
JournalCancer Medicine
Volume10
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • acute myeloid leukemia
  • allogeneic stem cell transplant
  • karnofsky performance status score
  • myeloablative conditioning
  • reduced intensity conditioning

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