Characteristics predicting outcomes of allogeneic stem-cell transplantation in relapsed acute myelogenous leukemia

Background Allogeneic hematopoietic stem-cell transplantation (aHSCT) is associated with significant morbidity and mortality, but it can cure carefully selected patients with acute myeloid leukemia (AML) in second remission (CR2). In a cohort of patients with AML who underwent aHSCT in CR2, we determined the pre-transplant factors that predicted for overall survival (os), relapse, and non-relapse mortality. We also sought to validate the prognostic risk groups derived by Michelis and colleagues in this independent population. Methods In a retrospective chart review, we obtained data for 55 consecutive patients who underwent aHSCT for AML in CR2. Hazard ratios were used to describe the independent effects of pre-transplant variables on outcome, and Kaplan-Meier curves were used to assess outcomes in the three prognostic groups identified by Michelis and colleagues. Results At 1, 3, and 5 years post-transplant, os was 60%, 45.5%, and 37.5% respectively. Statistically significant differences in os, relapse mortality, and non-relapse mortality were not identified between the prognostic risk groups identified by Michelis and colleagues. Women were less likely than men to relapse, and a modified European Society for Blood and Marrow Transplantation (mEBMT) score of 3 or less was associated with a lower non-relapse mortality. Conclusions The 37.5% 5-year os in this cohort suggests that, compared with other options, aHSCT offers patients with AML in CR2 a better chance of cure. Our study supports the use of the mEBMT score to predict non-relapse mortality in this population.