Impact of pre-transplant induction and consolidation cycles on AML allogeneic transplant outcomes: a CIBMTR analysis in 3113 AML patients

• DOI: 10.1038/s41375-022-01738-3
• Publication Date: 2022-10-30T06:02:40Z
• Authors: Michael Boyiadzis; Mei-Jie Zhang; Karen Chen; Hisham Abdel-Azim; Muhammad Bilal Abid; Mahmoud Aljurf; Ulrike Bacher; Talha Badar; Sherif M. Badawy; Minoo Battiwalla; Nelli Bejanyan; Vijaya Raj Bhatt; Valerie I. Brown; Paul Castillo; Jan Cerny; Edward A. Copelan; Charles Craddock; Bhagirathbhai Dho...; Miguel Angel Diaz...; Christen L. Ebens; Robert Peter Gale; Siddhartha Ganguly; Lohith Gowda; Michael R. Grunwald; Shahrukh Hashmi; Gerhard C. Hildeb...; Madiha Iqbal; Omer Jamy; Mohamed A. Kharfa...; Nandita Khera; Hillard M. Lazarus; Richard Lin; Dipenkumar Modi; Sunita Nathan; Taiga Nishihori; Sagar S. Patel; Attaphol Pawarode; Wael Saber; Akshay Sharma; Melhem Solh; John L. Wagner; Trent Wang; Kirsten M. Williams; Lena E. Winestone; Baldeep Wirk; Amer Zeidan; Christopher S. Ho...; Mark Litzow; Partow Kebriaei; Marcos de Lima; Kristin Page; Daniel J. Weisdorf
• Keywords: Homologous; Myeloid; Adult; Transplantation; Leukemia; Transplantation Conditioning; Hematopoietic Stem Cell Transplantation; Acute; Leukemia, Myeloid, Acute; 03 medical and health sciences; Neoplasm Recurrence; 0302 clinical medicine; Local; Humans; Transplantation, Homologous; Neoplasm Recurrence, Local; Retrospective Studies

We investigated the impact of the number of induction/consolidation cycles on outcomes of 3113 adult AML patients who received allogeneic hematopoietic cell transplantation (allo-HCT) between 2008 and 2019. Patients received allo-HCT using myeloablative (MAC) or reduced-intensity (RIC) conditioning in first complete remission (CR) or with primary induction failure (PIF). Patients who received MAC allo-HCT in CR after 1 induction cycle had 1.3-fold better overall survival (OS) than 2 cycles to CR and 1.47-fold better than ≥3 cycles. OS after CR in 2 or ≥3 cycles was similar. Relapse risk was 1.65-fold greater in patients receiving ≥3 cycles to achieve CR. After RIC allo-HCT, the number of induction cycles to CR did not affect OS. Compared to CR in 1 cycle, relapse risk was 1.24-1.41-fold greater in patients receiving 2 or ≥3 cycles. For patients receiving only 1 cycle to CR, consolidation therapy prior to MAC allo-HCT was associated with improved OS vs. no consolidation therapy. Detectable MRD at the time of MAC allo-HCT did not impact outcomes while detectable MRD preceding RIC allo-HCT was associated with an increased risk of relapse. For allo-HCT in PIF, OS was significantly worse than allo-HCT in CR after 1-3 cycles.