Long-term survival outcomes in patients with AML who were alive and disease-free 2 years after allo-HSCT

Although most deaths following allo-HSCT occur in the first 2 years post transplantation, long-term survivors are still at risk of late complications.1 A large, multicenter, retrospective, EBMT registry-based study assessed long-term survival and prognostic factors of late relapse in adult patients with acute leukemia who were alive and disease-free at 2 years after allo-HSCT. This analysis included 9,027 patients with AML who underwent allo-HSCT between 2005 and 2012. Results were published in Hemasphere by Larue et al.1

Key learnings

The 10-year probability for OS and LFS was 76.2% and 72.3%, respectively.

The cumulative RI and NRM at 10 years was 15.6% and 12.1%, respectively, and the probability of cGRFS at 10 years was 68.1%.

Patient- and disease-specific factors: Older age and adverse cytogenetic profiles were associated with worse survival outcomes.

Transplant-specific factors: PB grafts vs BM grafts, and female donor to male recipient transplantation were associated with inferior survival outcomes. The use of RIC vs MAC was associated with higher OS, LFS, and NRM, and the use of ATG was associated with higher OS and LFS, and lower NRM and cGvHD.

Relapses (42.7%) and cGvHD (17.0%) were the most common cause of late mortality.

These findings underscore the importance of optimizing pre-transplant strategies and the need for targeted interventions and surveillance strategies in long-term survivorship care to reduce late complications and improve survival outcomes.

Abbreviations: allo-HSCT, allogeneic hematopoietic stem cell transplantation; AML, acute myeloid leukemia; ATG, antithymocyte globulin; BM, bone marrow; cGRFS, composite of chronic graft‐versus‐host disease‐free and relapse‐free survival; cGvHD, chronic graft-versus-host disease; EBMT, European Society for Blood and Marrow Transplantation; LFS, leukemia-free survival; MAC, myeloablative conditioning; NRM, non-relapse mortality; OS, overall survival; PB, peripheral blood; RI, relapse incidence; UD, unrelated donor.