Allogeneic hematopoietic stem cell transplantation using reduced intensity conditioning regimen for patients with acute myeloid leukemia not in complete remission

Yoshimitsu Shimomura; Tetsuhisa Kitamura; Masamitsu Yanada; Shohei Mizuno; Tadakazu Kondo; Satoshi Yoshihara; Masatsugu Tanaka; Kazuki Inai; Yuta Katayama; Makoto Onizuka; Takahiro Fukuda; Hirohisa Nakamae; Mineo Kurokawa; Shingo Yano; Miho Nara; Masayoshi Masuko; Shigesaburo Miyakoshi; Tetsuya Eto; Makoto Yoshimitsu; Fumihiko Ishimaru; Junya Kanda; Yoshiko Atsuta; Takaaki Konuma

doi:10.1016/j.jcyt.2024.11.012

Allogeneic hematopoietic stem cell transplantation using reduced intensity conditioning regimen for patients with acute myeloid leukemia not in complete remission

Cytotherapy. 2024 Nov 17:S1465-3249(24)00937-X. doi: 10.1016/j.jcyt.2024.11.012. Online ahead of print.

Authors

Yoshimitsu Shimomura¹, Tetsuhisa Kitamura², Masamitsu Yanada³, Shohei Mizuno⁴, Tadakazu Kondo⁵, Satoshi Yoshihara⁶, Masatsugu Tanaka⁷, Kazuki Inai⁸, Yuta Katayama⁹, Makoto Onizuka¹⁰, Takahiro Fukuda¹¹, Hirohisa Nakamae¹², Mineo Kurokawa¹³, Shingo Yano¹⁴, Miho Nara¹⁵, Masayoshi Masuko¹⁶, Shigesaburo Miyakoshi¹⁷, Tetsuya Eto¹⁸, Makoto Yoshimitsu¹⁹, Fumihiko Ishimaru²⁰, Junya Kanda²¹, Yoshiko Atsuta²², Takaaki Konuma²³

Affiliations

¹ Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan; Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Japan. Electronic address: shimomura_0119@yahoo.co.jp.
² Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Japan.
³ Department of Hematology and Oncology, Nagoya City University East Medical Center, Nagoya, Japan.
⁴ Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
⁵ Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan.
⁶ Department of Hematology, Hyogo Medical University Hospital, Hyogo, Japan.
⁷ Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
⁸ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁹ Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
¹⁰ Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan.
¹¹ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹² Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
¹³ Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Japan.
¹⁴ Clinical oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan.
¹⁵ Division of Hematology, Nephrology and Rheumatology, Akita University Hospital, Akita, Japan.
¹⁶ Department of Hematopoietic Cell Therapy, Department of Hematology, Niigata University Medical and Dental Hospital, Niigata, Japan.
¹⁷ Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
¹⁸ Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
¹⁹ Department of Hematology and Rheumatology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
²⁰ Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Kanagawa, Japan.
²¹ Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²² Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan.
²³ Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.

PMID: 39625431
DOI: 10.1016/j.jcyt.2024.11.012

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative treatment option for patients with refractory and relapsed acute myeloid leukemia (R/R AML) not in complete remission. Many studies investigating the prognosis of patients with R/R AML not in remission focused on patients who received myeloablative conditioning regimen (MAC). Conversely, reduced intensity conditioning regimen (RIC) could be a considerable conditioning regimen for some patients because of the high frequency of R/R AML in older patients who are not candidates for MAC.

Objective: This study aimed to evaluate the prognosis and identify factors associated with outcomes in patients with R/R AML who underwent allogeneic HSCT with RIC.

Study design: This study included 707 adult patients with AML not in complete remission who had received RIC. The primary endpoint was progression-free survival (PFS), which was estimated using the Kaplan-Meier method. Prognostic factors were identified using a Cox proportional hazards model with multiple imputations using a chained equation approach.

Results: The 5-year PFS, overall survival, relapse, and nonrelapse mortality were 18.8% (95% confidence interval [CI]: 15.6-22.2), 22.0% (95% CI: 8.5-25.7), 53.6% (95% CI 49.7-57.4%) and 27.5% (95% CI: 24.0-31.2), respectively. Multivariable analysis revealed that male sex, poor performance status, karyotype risk, and blasts in the peripheral blood were significantly associated with PFS.

Conclusions: This study identified prognostic factors in patients with R/R AML not in complete remission. These results can help to develop a transplant strategy for the treatment of R/R AML.

Keywords: acute myeloid leukemia; allogeneic hematopoietic stem cell transplantation; not in complete remission; reduced intensity conditioning regimen.