High probability of long-term survival in 2-year survivors of autologous hematopoietic cell transplantation for AML in first or second CR

Abstract

We describe the long-term outcomes of autologous hematopoietic cell transplantation (HCT) for 315 AML patients in first or second complete remission (CR). All patients were in continuous CR for ≥2 years after HCT. Patients were predominantly transplanted in CR1 (78%) and had good or intermediate cytogenetic risk disease (74%). Median follow-up of survivors was 106 (range, 24-192) months. Overall survival at 10 years after HCT was 94% (95% confidence intervals, 89-97%) and 80% (67-91%) for patients receiving HCT in CR1 and CR2, respectively. The cumulative incidence of relapse at 10 years after HCT was 6% (3-10%) and 10% (3-20%) and that of nonrelapse mortality was 5% (2-9%) and 11% (4-21%), respectively. On multivariate analysis, HCT in CR2 (vs CR1), older age at transplantation and poor cytogenetic risk disease were independent predictors of late mortality and adverse disease-free survival. The use of growth factors to promote engraftment after HCT was the only risk factor for relapse. Relative mortality of these 2-year survivors was comparable to that of age-, race- and gender-matched normal population. Patients who receive autologous HCT for AML in CR1 or CR2 and remain in remission for ≥2 years have very favorable long-term survival. Their mortality rates are similar to that of the general population.

Figure 1

Overall survival of patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for acute myeloid leukemia (by disease status at transplant)

Figure 2

Non-relapse mortality among patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for acute myeloid leukemia (by disease status at transplant)

Figure 3

Relative excess mortality (solid line) compared to age-, gender- and race- matched general population for patients surviving in remission for at least 2-years after autologous hematopoietic-cell transplant for acute myeloid leukemia. A relative risk of 1 indicates that the mortality rate of the population of interest is similar to that of the general population. Dashed lines represent 95% pointwise confidence intervals. The population mortality rate is the same as that in our study cohort whenever the upper and lower 95% confidence bands include 1 in between them. From 4 years after transplantation, there was no difference in mortality rates between our study cohort and the matched general population. The confidence bands widen over time as fewer patients are at risk.