Is stem cell transplantation a viable option among AML patients who are not in remission?

This study examined stem cell transplant outcomes across acute myeloid leukemia (AML) patients with different disease status. Researchers reported superior survival after a stem cell transplant among patients in second complete remission. 

Stem cell transplantation is considered the most effective therapy for high-risk AML patients who have achieved complete remission after treatment. It can also improve survival for patients who fail to achieve complete remission or those with disease relapse after first remission. There is evidence suggesting that immediate transplantation is the best strategy in such a case. Other studies indicate that additional therapy to achieve remission before a transplant has superior outcomes.   

The aim of this study was to assess stem cell transplantation outcomes across different AML disease status. Information on 4,682 patients was analyzed. 1,440 of the patients included did not achieve first remission (failure of primary therapy). 1,256 patients were in relapse after first remission. 1,986 patients were in second complete remission. All patients underwent a stem cell transplant from a donor. Patients were followed for an average of 5 years.

There were no significant differences in donor type across the 3 groups. Genetic abnormalities (associated with a poorer AML prognosis) were more common in the group who did not achieve first remission.

The overall survival rate (proportion who have not died from any cause since treatment) at 5 years was 39% for patients in second complete remission. This was significantly greater compared to patients who did not achieve first remission (21%) and those in relapse after first remission (18%). Analysis accounted for disease burden, genetic abnormalities, and donor type.

The relapse rate at 5 years for patients in second remission was 32%. It was similar for those unable to reach first remission (40%) and those in first relapse (41%). Older age (50 years or older), high disease burden, genetic abnormalities, and poorly matched donors were all factors that increased the risk of relapse. 

Researchers reported superior survival after a stem cell transplant among patients in second complete remission. Some patients unable to achieve first remission or in relapse after first remission may also benefit from an early stem cell transplant. This particularly applies to younger patients with a low disease burden.