Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT). (26th November 2020)

• Record Type: Journal Article
• Authors: Saraceni, Francesco; Labopin, Myriam; Forcade, Edouard; Kröger, Nicolaus; Socié, Gerard; Niittyvuopio, Riitta; Cornelissen, Jan J.; Labussière‐Wallet, Hélène; Blaise, Didier; Choi, Goda; Byrne, Jenny L.; Guillerm, Gaelle; Marchand, Tony; Esteve, Jordi; Bazarbachi, Ali; Savani, Bipin; Olivieri, Attilio; Nagler, Arnon; Mohty, Mohamad
• Is Part Of: Cancer medicine. Volume 10:Number 1(2021)
• Page Start: 23
• Page End: 33
• Publication Date: 2020-11-26
• Subjects: acute myeloid leukemia -- allogeneic stem cell transplant -- karnofsky performance status score -- myeloablative conditioning -- reduced intensity conditioning; 616.994005
• DOI: 10.1002/cam4.3593
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo‐SCT) with a reduced performance status. We herein present the results of a registry study on 2, 936 AML patients undergoing allo‐SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two‐year leukemia‐free survival (LFS), overall survival (OS) and graft‐versus‐host disease (GVHD)‐free, and relapse‐free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non‐relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% ( p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced‐intensity conditioning (RIC) regimen was associated with an increased risk of relapse ( p = 0.002) and lower GRFS ( p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM ( p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS ( p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III‐IV acute GVHD ( p < 0.01) and NRM ( p < 0.01) in comparison to other donor types. In conclusion, allo‐SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment. Abstract : Graft‐versus‐host disease‐free, relapse‐free survival in patients with KPS score < 80% receiving MAC or RIC regimen.