Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients With Acute Myeloid Leukemia Harboring Rearrangement and Its Prognostic Factors
| Autor: | Bingqian Jiang, Yanmin Zhao, Yi Luo, Jian Yu, Yi Chen, Baodong Ye, Huarui Fu, Xiaoyu Lai, Lizhen Liu, Yishan Ye, Weiyan Zheng, Jie Sun, Jingsong He, Yi Zhao, Guoqing Wei, Zhen Cai, He Huang, Jimin Shi |
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| Jazyk: | angličtina |
| Rok vydání: | 2024 |
| Předmět: | |
| Zdroj: | Cell Transplantation, Vol 33 (2024) |
| Druh dokumentu: | article |
| ISSN: | 1555-3892 09636897 |
| DOI: | 10.1177/09636897231225821 |
| Popis: | KMT2A rearrangement ( KMT2A -r) in patients with acute myeloid leukemia (AML) is associated with poor outcomes; the prognostic factors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain unclear. We investigated 364 adults with AML who underwent allo-HSCT between April 2016 and May 2022, and 45 had KMT2A -r among them. Propensity score analysis with 1:1 matching and the nearest neighbor matching method identified 42 patients in KMT2A -r and non– KMT2A -r cohorts, respectively. The 2-year overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapsed mortality rates of patients with KMT2A -r ( n = 45) were 59.1%, 49.6%, 41.5%, and 8.9%, respectively. Using propensity score matching, the 2-year OS rate of patients with KMT2A -r ( n = 42) was lower than that of those without KMT2A -r ( n = 42; 56.1% vs 88.1%, P = 0.003). Among patients with KMT2A -r ( n = 45), the prognostic advantage was exhibited from transplantation in first complete remission (CR1) and measurable residual disease (MRD) negative, which was reflected in OS, RFS, and CIR ( P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, patients with AF6 had poorer outcomes than those with AF9 , ELL , and other KMT2A -r subtypes ( P = 0.032, P = 0.001, and P = 0.001 for OS, RFS, and CIR, respectively). However, no differences were found in the OS, RFS, and CIR between patients with KMT2A -r with and without mutations (all P > 0.05). Univariate and multivariate analyses revealed that achieving CR1 MRD negative before HSCT was a protective factor for OS [hazard ratio (HR) = 0.242, P = 0.007], RFS (HR = 0.350, P = 0.036), and CIR (HR = 0.271, P = 0.021), while AF6 was a risk factor for RFS (HR = 2.985, P = 0.028) and CIR (HR = 4.675, P = 0.004). The prognosis of patients with KMT2A -r AML was poor, particularly those harboring AF6 -related translocation; however, it is not associated with the presence of mutations. These patients can benefit from achieving CR1 MRD negative before HSCT. |
| Databáze: | Directory of Open Access Journals |
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