Allogeneic Stem Cell Transplantation in De Novo Core-binding Factor Acute Myeloid Leukemia in First Complete Remission: Data from the EBMT

Overview

Journal Bone Marrow Transplant

Specialty General Surgery

Date 2024 Aug 2

PMID 39095548

Authors

Rama Al Hamed

Myriam Labopin

Depei Wu

Tobias Gedde-Dahl

Mahmoud Aljurf

Edouard Forcade

Urpu Salmenniemi

Jakob Passweg

Johan Maertens

Thomas Pabst

Jurjen Versluis

Maija Itala-Remes

Xiao-Jun Huang

Gwendolyn Van Gorkom

Thomas Schroeder

Jaime Sanz

Didier Blaise

Peter Remenyi

Urs Schanz

Jordi Esteve

Norbert-Claude Gorin

Fabio Ciceri

Mohamad Mohty

Affiliations

Soon will be listed here.

Abstract

Core-binding factor acute myeloid leukemia (CBF-AML) represents 12-15% of all AML cases. Although CBF positivity infers a survival advantage, overall survival (OS) remains dismal. Treatment is with cytarabine/anthracycline-based chemotherapy induction followed by high-dose cytarabine (HiDAC) consolidation. Allogeneic hematopoietic stem cell transplantation (allo-SCT) is reserved for relapse or for patients having not achieved MRD-negativity at high risk for relapse. The role of SCT in first complete remission (CR1) remains controversial and is considered in high risk conditions. In this retrospective, multi-national, European Society for Blood and Marrow Transplantation (EBMT)-based study, we identified 1901 patients with de novo CBF-AML who received an allo-SCT or autologous transplantation (ASCT) in CR1. 65.5% harbored t(8;21) and 34.4% inv(16). In this group, the majority (77%) were treated with allo-SCT in CR1. In multivariate analysis, treatment with allo-SCT was an independent and significant, negative predictor of NRM and OS (HR 4.26, p < 0.0001 and HR 1.67, p = 0.003) and among patients treated with allo-SCT, those treated with MSD had the best outcomes, comparable to those treated with ASCT. There was no interaction between the type of transplant and MRD status at time of SCT. In both, MRD-negative and MRD-positive groups, NRM was worse in the allo-SCT group (MRD-: 12.9% vs 5.2%, p = 0.007; MRD+: 10.6% vs 0%, p = 0.004). We therefore demonstrated that consolidation in CR1 with allo-SCT results in worse outcomes than ASCT. Whether consolidation with ASCT yields better outcomes than chemotherapy alone or chemotherapy in combination with Gemtuzumab Ozogamicin is yet to be investigated.

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