Open AccessPersonalized prediction of overall survival in patients with AML in non‐complete remission undergoing allo‐HCT
Author(s) -
Hirabayashi Shigeki,
Uozumi Ryuji,
Kondo Tadakazu,
Arai Yasuyuki,
Kawata Takahito,
Uchida Naoyuki,
Marumo Atsushi,
Ikegame Kazuhiro,
Fukuda Takahiro,
Eto Tetsuya,
Tanaka Masatsugu,
Wake Atsushi,
Kanda Junya,
Kimura Takafumi,
Tabuchi Ken,
Ichinohe Tatsuo,
Atsuta Yoshiko,
Yanada Masamitsu,
Yano Shingo
Publication year - 2021
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.3920
Subject(s) - medicine , oncology , hazard ratio , fludarabine , transplantation , myeloid leukemia , cyclophosphamide , total body irradiation , regimen , hematopoietic stem cell transplantation , nomogram , proportional hazards model , chemotherapy , confidence interval
Abstract Allogenic hematopoietic stem cell transplantation (allo‐HCT) is the standard treatment for acute myeloid leukemia (AML) in non‐complete remission (non‐CR); however, the prognosis is inconsistent. This study aimed to develop and validate nomograms and a web application to predict the overall survival (OS) of patients with non‐CR AML undergoing allo‐HCT (cord blood transplantation [CBT], bone marrow transplantation [BMT], and peripheral blood stem cell transplantation [PBSCT]). Data from 3052 patients were analyzed to construct and validate the prognostic models. The common significant prognostic factors among patients undergoing allo‐HCT were age, performance status, percentage of peripheral blasts, cytogenetic risk, chemotherapy response, and number of transplantations. The conditioning regimen was a significant prognostic factor only in patients undergoing CBT. Compared with cyclophosphamide/total body irradiation, a conditioning regimen of ≥3 drugs, including fludarabine, with CBT exhibited the lowest hazard ratio for mortality (0.384; 95% CI, 0.266–0.554; p < 0.0001). A conditioning regimen of ≥3 drugs with CBT also showed the best leukemia‐free survival among all conditioning regimens. Based on the results of the multivariable analysis, we developed prognostic models showing adequate calibration and discrimination (the c‐indices for CBT, BMT, and PBSCT were 0.648, 0.600, and 0.658, respectively). Our prognostic models can help in assessing individual risks and designing future clinical studies. Furthermore, our study indicates the effectiveness of multi‐drug conditioning regimens in patients undergoing CBT.