How can cytogenetic-risk status affect the outcome of cell transplants for acute myeloid leukaemia patients?

This study aimed to investigate the post-hematopoietic (stem) cell transplant outcomes for older patients with AML in their second complete remission.

This study concluded that hematopoietic cell transplant is a good treatment option, especially for patients with favorable- or intermediate-cytogenetic risk status. 

Acute myeloid leukemia (AML) occurs when abnormal myeloblasts are produced. Myeloblasts are a type of white blood cell that produce other cells. Abnormal myeloblasts cannot produce healthy cells. Lack of healthy cells can lead to a weak immune system, infection and bleeding.

An allogenic hematopoietic cell transplant (HCT) is a potential cure for older patients with AML in their first complete remission (no signs of cancer). It involves taking stem cells from a donor and putting them into the AML patient. Stem cells can produce any cell type and help to restore the immune system.

Cytogenetic-risk status is different for each patient and is thought to be a factor that can influence treatment outcomes.  

It was not known what the outcomes for older patients in their second complete remission would be post-HCT and what influence cytogenetic-risk status would have. 

The aim of this study was to look at factors that influence the post-HCT outcomes in the second complete remission. This study involved 196 patients aged 60 and older who underwent HCT for AML in their second complete remission. 81% received reduced-intensity conditioning (chemotherapy) before HCT.

The three-year overall survival (OS, time from treatment until death from any cause) rate for patients who underwent HCT was 42%. The three-year leukemia-free survival rate for patients who underwent HCT was 37%.

The non-relapse mortality rate (death due to causes other than AML returning) for patients who underwent HCT was 25%. The relapse rate (cancer returns) was 38%.

Cytogenetic risk was the only factor that influenced OS. Patients with intermediate-risk cytogenetics were 14% more likely to have reduced OS. Patients with unfavorable-risk cytogenetics were 2.32 times more likely to have reduced OS.

Cytogenetic risk was the only factor that influenced the relapse rate. Patients with intermediate-risk cytogenetics were 10% more likely to have an increased relapse rate. Patients with unfavorable-risk cytogenetics were almost 3 times more likely to have an increased relapse rate.

This study concluded that allogeneic HCT is a treatment option for older patients with AML in their second remission that may be curative. Patients with favorable- or intermediate-cytogenetic risk are more likely to benefit.  

Larger studies need to be carried out. 

Consult your physician about HCT as a treatment option for AML.