Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia

Abstract

Following chemotherapy, secondary acute myeloid leukemia (sAML), occurring after antecedent hematologic diseases, previous chemotherapy or radiation, has an inferior prognosis compared with de novo AML. To define the outcome of sAML in the context of allogeneic stem cell transplantation (alloSCT), a retrospective, registry-based comparison was performed, including 11,439 patients with de novo and 1325 with sAML. Among transplants in first complete remission (CR1) (n = 8,600), the 3-year cumulative incidence of relapse (RI) and non-relapse mortality (NRM) was 28.5% and 16.4% for de novo, and 35% and 23.4% for sAML. Three-year overall survival (OS), leukemia-free survival (LFS) and Graft-versus-Host Disease/relapse-free survival (GRFS) was 60.8%, 55.1%, and 38.6% for de novo, and 46.7%, 41.6%, and 28.4% for sAML, respectively. In multivariate analysis, sAML was associated with a lower OS (HR = 1.33 [95% CI = 1.21-1.48]; p < 10^-5), LFS (HR = 1.32 [95% CI = 1.19-1.45]; p < 10^-5) and GRFS (HR = 1.2 [95% CI = 1.1-1.31]; p < 10^-4) and higher NRM (HR = 1.37 [95% CI = 1.17-1.59]; p < 10^-4) and RI (HR = 1.27 [95% CI = 1.12-1.44]; p < 10^-3). Results of the Cox model were confirmed in a matched-pair analysis. In contrast, results did not differ between de novo and sAML after alloSCT in induction failure or relapse. Hence, this analysis identified sAML as an independent risk factor for outcome after alloSCT in CR1.

Fig. 1. Outcome of patients with either de novo or secondary AML after alloSCT in CR1.

RI Incidence of relapse, OS Overall survival, NRM Non-relapse mortality, LFS Leukemia-free survival (p = 8.6 × 10⁻⁵, NRM: p < 10⁻⁵, LFS: p < 10⁻⁵, OS: p < 10⁻⁵).