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The differential effect of disease status at allogeneic hematopoietic cell transplantation on outcomes in acute myeloid and lymphoblastic leukemia

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Abstract

This study aimed to compare the effect of disease status at the time of allogeneic hematopoietic cell transplantation (HCT) on post-transplant outcomes between acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Japanese nationwide registry data for 6901 patients with AML and 2469 patients with ALL were analyzed. In this study, 2850 (41%), 937 (14%), 62 (1%), and 3052 (44%) AML patients and 1751 (71%), 265 (11%), 23 (1%), and 430 (17%) ALL patients underwent transplantation in first complete remission (CR1), second CR (CR2), third or subsequent CR (CR3 +), and non-CR, respectively. The probabilities of overall survival at 5 years for patients transplanted in CR1, CR2, CR3 + , and non-CR were 58%, 61%, 41%, and 26% for AML patients and 67%, 45%, 20%, and 21% for ALL patients, respectively. Multivariate analyses revealed that the risks of relapse and overall mortality were similar for AML patients transplanted in CR1 and CR2 (P = 0.672 and P = 0.703), whereas they were higher for ALL patients transplanted in CR2 than for those transplanted in CR1 (P < 0.001 for both). The risks of relapse and overall mortality for those transplanted in CR3 + and non-CR increased in a stepwise manner for both diseases, with the relevance being stronger for ALL than for AML patients. These results suggest a significant difference in the effect of disease status at HCT on post-transplant outcomes in AML and ALL. Further investigation to incorporate measurable residual disease data is warranted.

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Funding

This work was supported in part by a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED), grant number: 19ek0510023h0002, and a grant from the Aichi Cancer Research Foundation, grant number: 2021–1-9.

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Authors and Affiliations

  1. Department of Hematology and Cell Therapy, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Masamitsu Yanada

  2. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

  3. Kyusyu University Beppu Hospital, Beppu, Japan

    Satoshi Yamasaki

  4. Aichi Medical University, Nagakute, Japan

    Shohei Mizuno

  5. Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Shigeki Hirabayashi

  6. Nagoya University Hospital, Nagoya, Japan

    Satoshi Nishiwaki

  7. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  8. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  9. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  10. Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  11. Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  12. Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  13. National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  14. Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  15. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  16. Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  17. Japanese Red Cross Kinki Block Blood Center, Osaka, Japan

    Takafumi Kimura

  18. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  19. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  20. Jichi Medical University Saitama Medical Center, Saitama, Japan

    Shinichi Kako

  21. The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

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  1. Masamitsu Yanada
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Correspondence to Masamitsu Yanada.

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The study was approved by the institutional review board of the Aichi Cancer Center, and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from each patient.

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Yanada, M., Konuma, T., Yamasaki, S. et al. The differential effect of disease status at allogeneic hematopoietic cell transplantation on outcomes in acute myeloid and lymphoblastic leukemia. Ann Hematol 100, 3017–3027 (2021). https://doi.org/10.1007/s00277-021-04661-2

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