Depth of Response to Intensive Chemotherapy Has Significant Prognostic Value among Acute Myeloid Leukemia (AML) Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation with Intermediate or Adverse Risk at Diagnosis Compared to At-Risk Group According to European Leukemia Net 2017 Risk Stratification

• Published in: Cancers Vol. 14; no. 13; p. 3199
• Main Authors: Kim, Tong-Yoon, Park, Silvia, Kwag, Daehun, Lee, Jong-Hyuk, Lee, Joonyeop, Min, Gi-June, Park, Sung-Soo, Jeon, Young-Woo, Shin, Seung-Hawn, Yahng, Seung-Ah, Yoon, Jae-Ho, Lee, Sung-Eun, Cho, Byung-Sik, Eom, Ki-Seong, Kim, Yoo-Jin, Lee, Seok, Min, Chang-Ki, Cho, Seok-Goo, Lee, Jong-Wook, Kim, Hee-Je
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 29.06.2022; MDPI
• Subjects: Acute myeloid leukemia; At risk populations; Bone marrow; Cell cycle; Chemotherapy; Genomes; Graft versus host disease; Health risk assessment; Leukemia; Multivariate analysis; Mutation; Patients; Remission; Risk groups; Stem cell transplantation; Transplants & implants; Tumors; Variables; United States > US; ELN 2017 risk classification; allogeneic transplantation; acute myeloid leukemia; prognosis
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14133199

We evaluated the prognostic efficiency of the European Leukemia Net (ELN) 2017 criteria on the post-transplant outcomes of 174 patients with intermediate (INT; n = 108, 62%) or adverse (ADV) risk (n = 66, 38%) of acute myeloid leukemia; these patients had received the first allogeneic hematopoietic stem-cell transplantation (HSCT) at remission. After a median follow-up period of 18 months, the 2 year OS, RFS, and CIR after HSCT were estimated to be 58.6% vs. 64.4% (p = 0.299), 50.5% vs. 53.7% (p = 0.533), and 26.9% vs. 36.9% (p = 0.060) in the INT and ADV risk groups, respectively. Compared to the ELN 2017 stratification, pre-HSCT WT1 levels (cutoff: 250 copies/104 ABL) more effectively segregated the post-HSCT outcomes of INT risk patients compared to ADV risk patients regarding their 2 year OS (64.2% vs. 51.5%, p = 0.099), RFS (59.4% vs. 32.4%, p = 0.003), and CIR (18.9% vs. 60.0% p < 0.001). Indeed, high WT1 levels were more prominent in INT risk patients than in ADV risk patients. Notably, FLT3-ITD had the greatest impact on post-HSCT outcomes among all the ELN 2017 criteria components; patients in the FLT3-ITD mutant subgroups exhibited the worst outcomes regardless of their allelic ratios or NPM1 status compared to the pre-HSCT WT1 level of other INT and ADV risk patients.