Applicability of the acute leukemia (AL) - EBMT score as a prognostic model for allogeneic hematopoietic stem cell transplantation: a single-center, prospective, cohort study at a reference transplant center in Brazil

Gustavo Machado Teixeira; Glaucia Helena Martinho; Antonio Vaz de Macedo; Ana Luiza Roscoe Santoro; Marisa Ribeiro Verçosa; Fernanda Maia Lodi; Vandack Nobre

doi:10.1016/j.htct.2021.04.004

Applicability of the acute leukemia (AL) - EBMT score as a prognostic model for allogeneic hematopoietic stem cell transplantation: a single-center, prospective, cohort study at a reference transplant center in Brazil

Hematol Transfus Cell Ther. 2023 Jan-Mar;45(1):38-44. doi: 10.1016/j.htct.2021.04.004. Epub 2021 Jun 10.

Authors

Gustavo Machado Teixeira¹, Glaucia Helena Martinho², Antonio Vaz de Macedo³, Ana Luiza Roscoe Santoro⁴, Marisa Ribeiro Verçosa², Fernanda Maia Lodi², Vandack Nobre⁵

Affiliations

¹ Hospital das Clínicas da Universidade Federal de Minas Gerais (HC UFMG), Belo Horizonte, MG, Brazil; Hospital Alberto Cavalcanti/ FHEMIG, Belo Horizonte, MG, Brazil. Electronic address: Gustmteixeira@yahoo.com.br.
² Hospital das Clínicas da Universidade Federal de Minas Gerais (HC UFMG), Belo Horizonte, MG, Brazil.
³ Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, MG, Brazil.
⁴ Hospital das Clínicas da Universidade Federal de Minas Gerais (HC UFMG), Belo Horizonte, MG, Brazil; Fundação Hemominas, Belo Horizonte, MG, Brazil.
⁵ Faculdade de Medicina da Universidade Federal de Minas Gerais (FMUFMG), Belo Horizonte, MG, Brazil.

Abstract

Introduction: The Acute Leukemia-European Society for Blood and Marrow Transplantation (AL-EBMT) risk score was recently developed and validated by Shouval et al. OBJECTIVE: To assess the ability of this score in predicting the 2-year overall survival (OS-2), leukemia-free survival (LFS-2) and transplant-related mortality (TRM) in acute leukemia (AL) adult patients undergoing a first allogeneic hematopoietic stem cell transplant (HSCT) at a transplant center in Brazil.

Methods: In this prospective, cohort study, we used the formula published by Shouval et al. to calculate the AL-EBMT score and stratify patients into three risk categories.

Results: A total of 79 patients transplanted between 2008 and 2018 were analyzed. The median age was 38 years. Acute myeloid leukemia was the most common diagnosis (68%). Almost a quarter of the cases were at an advanced stage. All hematopoietic stem cell transplantations (HSCTs) were human leukocyte antigen-matched (HLA-matched) and the majority used familial donors (77%). Myeloablative conditioning was used in 92% of the cases. Stratification according to the AL-EBMT score into low-, intermediate- and high-risk groups yielded the following results: 40%, 12% and 47% of the cases, respectively. The high scoring group was associated with a hazard ratio of 2.1 (p = 0.007), 2.1 (p = 0.009) and 2.47 (p = 0.01) for the 2-year OS, LFS and TRM, respectively.

Conclusion: This study supports the ability of the AL-EBMT score to reasonably predict the 2-year post-transplant OS, LFS and TRM and to discriminate between risk categories in adult patients with AL, thus confirming its usefulness in clinical decision-making in this setting. Larger, multicenter studies may further help confirm these findings.

Keywords: Acute leukemia; European society for blood and marrow transplantation; Predictive model index; Predictive model score; Prognostic model.