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Haploidentical transplantation for acute myeloid leukemia patients with minimal/measurable residual disease at transplantation
Author(s) -
Srour Samer A.,
Saliba Rima M.,
Bittencourt Maria C. B.,
Perez Jorge M. R.,
Kongtim Piyanuch,
Alousi Amin,
AlAtrash Gheath,
Olson Amanda,
Betul Oran,
Mehta Rohtesh,
Popat Uday,
Hosing Chitra,
Bashir Qaiser,
Khouri Issa,
Kebriaei Partow,
Masarova Lucia,
Short Nicholas,
Jabbour Elias,
Daver Naval,
Konopleva Marina,
Ravandi Farhad,
Kantarjian Hagop,
Champlin Richard E.,
Ciurea Stefan O.
Publication year - 2019
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25647
Subject(s) - medicine , fludarabine , transplantation , hazard ratio , minimal residual disease , myeloid leukemia , cyclophosphamide , melphalan , oncology , gastroenterology , leukemia , surgery , chemotherapy , confidence interval
There have been conflicting results regarding the impact of minimal/measurable disease at transplant on acute myeloid leukemia (AML) outcomes after haploidentical transplantation (haplo‐SCT). We assessed the impact of pre‐transplant disease status on post‐transplant outcomes of 143 patients treated with haplo‐SCT using fludarabine‐melphalan (FM) conditioning and post‐transplant cyclophosphamide (PTCy). With a median follow‐up of 29 months, the two‐year PFS for all patients was 41%. Compared to patients in complete remission (CR) at transplant, those with active disease (n = 29) and CR with incomplete count recovery (CRi) (n = 39) had worse PFS. They had hazard ratios (HR) of 3.5 (95% CI: 2.05‐6.1; P < .001) and 2.3 (95% CI: 1.3‐3.9; P = .002), respectively. Among patients who were in CR at transplant, there were no differences in PFS between those who had minimal residual disease (MRD) positive (n = 24), and MRD negative (n = 41) (HR 1.85, 95%CI: 0.9‐4.0; P = .1). In multivariable analysis for patients in CR, only age was predictive for outcomes, while MRD status at transplant did not influence the treatment outcomes. Our findings suggest that haplo‐SCT with FM conditioning regimen and PTCy‐based GVHD prophylaxis has a protective effect, and may potentially abrogate the inferior outcomes of MRD positivity for patients with AML. Patients with positive MRD may benefit from proceeding urgently to a haplo‐SCT, as this does not appear to negatively impact transplant outcomes.