Determinants of refined GvHD-free, relapse-free survival after reduced-intensity allogeneic hematopoietic cell transplantation in older patients with myeloid malignancies. (April 2023)

• Record Type: Journal Article
• Authors: Jindra, Pavel; Karas, Michal; Lysák, Daniel; Šrámek, Jiří; Steinerová, Kateřina; Hrabětová, Marcela; Jungová, Alexandra
• Is Part Of: Leukemia research. Volume 127(2023)
• Publication Date: 2023-04
• Subjects: AML -- MDS -- Older -- Allogeneic HCT -- GRFS -- DRI -- Donor; AML Acute Myeloid Leukaemia -- MDS Myelodysplastic Syndrome -- HCT Hematopoietic Cell Transplantation -- GRFS GvHD-free, Relapse-Free Survival -- DRI Disease Risk Index -- GvHD Graft versus Host Disease; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2023.107052
• Languages: English
• ISSNs: 0145-2126

Abstract

Abstract: Background: Older patients with AML/MDS have a poor prognosis with alloHCT as the only curative option. However alloHCT is challenging given its high TRM. Recently, a composite endpoint of GRFS was proposed to define transplant success. A single centre retrospective analysis was performed to determine the main variables influencing GRFS. Patients and Methodsmethods: 91 consecutive patients≥ 60 years (median 64 years, range 60–74) with AML/MDS who received reduced-intensity alloHCT during 2001–2017 analysed. Disease risk index (DRI) at HCT was low/intermediate in 47pts (52%) and high in 44 pts (48%). Results: After median follow-up for survivors of 56 months (range 7–144), 37 (40.6%) patients were alive. The OS, LFS and GRFS were 61.4%, 58.1%, 49.1% at 1 year and 35.5%, 32.3% and 23.1% at 5 years, respectively. The 1-year and 5-year incidences of NRM and relapse were 26.9%, 21.3% and 47.9% and 35.4%, respectively. In univariate analysis, high DRI was the strongest factor for worse OS (HR 2.121; p = 0.049), LFS (HR 1.924; p = 0.0123) and GRFS (HR 2.319; p = 0.0005). The donor age ≥ 62 years had a negative impact on OS (HR 2.110; p = 0.0345) and GRFS (HR 2.014; p = 0.0341). High DRI (HR 2.652; p = 0.0003) and donor age (HR 2.304; p = 0.0257) retained its significance in multivariate analysis for GRFS. Conclusion: A significant portion of older patients with myeloid malignancies survive alloHCT without experiencing GRFS event with DRI as the main determinant of outcome. Negative impact of donor age≥ 62 years suggests preference of a young donor, regardless of being related or unrelated. Highlights: Selected older patients with AML/MDS can achieve excellent GVHD, Relapse-free survival after allogeneic HCT. Outcomes are mainly determined by the disease biology, i.e., cytogenetic risk category and disease status at HCT. Age alone should not be the basis for excluding AML/MDS patient from potentially a curative allogeneic HCT.