Complete Remission with Incomplete Blood Count Recovery Is a Strong Predictor of Nonrelapse Mortality in Acute Myeloid Leukemia Patients Undergoing Allogeneic Stem Cell Transplantation

Ivetta Danylesko, Jonathan Canaani, Avichai Shimoni, Joshua Fein, Noga Shem-Tov, Ronit Yerushalmi, Roni Shouval, Arnon Nagler

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Achievement of an initial complete remission (CR) following induction chemotherapy is tightly correlated with survival in acute myeloid leukemia (AML) patients, yet patients in CR with incomplete hematologic recovery (CRi) still experience improved outcomes compared with nonresponding patients. Whether CRi predicts prognosis in patients referred to an allogeneic stem cell transplantation (allo-SCT) is incompletely defined. In this analysis, we evaluated whether clinical outcomes of transplanted AML patients in CR and CRi were significantly different. Methods: A retrospective single-center analysis of all de novo AML patients who underwent an allo-SCT between 2001 and 2015. The cohort included all adult patients with AML who underwent a first allo-SCT either in first or second CR or CRi at the time of transplantation. Results: The study cohort included 186 CR patients and 44 CRi patients. In univariate analysis, CRi was associated with inferior 3-year survival and 3-year nonrelapse mortality (NRM) compared to CR (41 vs. 62%; p = 0.022 and 27 vs. 10%; p = 0.006, respectively). In multivariate analysis, CRi was associated with decreased rates of survival (hazard ratio [HR] 2.01; 95% CI, 1.24-3.25; p = 0.005) and NRM (HR, 3.5; 95% CI, 1.6-7.8; p = 0.002). Conclusion: CRi in transplanted AML patients is potentially a potent predictor of increased NRM and survival.

Original languageEnglish
Pages (from-to)613-619
Number of pages7
JournalActa Haematologica
Volume144
Issue number6
DOIs
StatePublished - 1 Nov 2021

Keywords

  • Acute myeloid leukemia
  • Allogeneic stem cell transplantation
  • Complete remission

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