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. 2024 Jul;205(1):280-290.
doi: 10.1111/bjh.19552. Epub 2024 Jun 4.

Early blast clearance during sequential conditioning prior to allogeneic stem cell transplantation in patients with acute myeloid leukaemia

Julian Ronnacker  1 , Marc-Andre Urbahn  1 , Christian Reicherts  1 , Lina Kolloch  1 , Philipp Berning  1 , Sarah Sandmann  2 , Eva Eßeling  1 , Simon Call  1 , Matthias Floeth  1 , Julia Marx  1 , Jörn Albring  1 , Jan-Henrik Mikesch  1 , Christoph Schliemann  1 , Georg Lenz  1 , Matthias Stelljes  1
Affiliations

Early blast clearance during sequential conditioning prior to allogeneic stem cell transplantation in patients with acute myeloid leukaemia

Julian Ronnacker et al. Br J Haematol. 2024 Jul.

Abstract

For patients with relapsed or refractory AML, sequential conditioning prior to allogeneic stem cell transplantation (alloSCT) is an established and potentially curative treatment option. Early response to treatment during conditioning indicates chemotherapy-responsive disease and may have prognostic value. We retrospectively evaluated blast clearance on day 5 after melphalan, administered 11 days prior to alloSCT as part of a sequential conditioning in 176 patients with active AML. Overall survival (OS) was 52% (95% confidence interval [CI] 45%-60%), and relapse-free survival (RFS) was 47% (95% CI 40%-55%) at 3 years. Patients who achieved early blast clearance did not show a significant improvement in OS and RFS (OS, hazard ratio [HR] HR 0.75, p 0.19; RFS, HR 0.71, p 0.09, respectively), but had a significantly lower non-relapse mortality rate (HR 0.46, p 0.017). HLA-mismatched donor, older age, adverse genetic risk and higher comorbidity scores were associated with inferior survival outcomes. A high initial blast count was only associated with inferior prognosis in patients receiving chemotherapy-only compared to total body irradiation containing conditioning therapy. These results indicate that for patients transplanted with active AML, sensitivity to chemotherapy might be of less importance, compared to other disease- and transplant-related factors.

Keywords: acute myeloid leukaemia; allogeneic stem cell transplantation; melphalan.

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