Comparison of outcomes of HCT in blast phase of BCR-ABL12 MPN with de novo AML and with AML following MDS

Vikas Gupta, Soyoung Kim, Zhen Huan Hu, Ying Liu, Mahmoud Aljurf, Ulrike Bacher, Amer Beitinjaneh, Jean Yves Cahn, Jan Cerny, Edward Copelan, Shahinaz M. Gadalla, Robert Peter Gale, Siddhartha Ganguly, Biju George, Aaron T. Gerds, Usama Gergis, Betty K. Hamilton, Shahrukh Hashmi, Gerhard C. Hildebrandt, Rammurti T. KambleTamila Kindwall-Keller, Hillard M. Lazarus, Jane L. Liesveld, Mark Litzow, Richard T. Maziarz, Taiga Nishihori, Richard F. Olsson, David Rizzieri, Bipin N. Savani, Sachiko Seo, Melhem Solh, Jeff Szer, Leo F. Verdonck, Baldeep Wirk, Ann Woolfrey, Jean A. Yared, Edwin P. Alyea, Uday R. Popat, Ronald M. Sobecks, Bart L. Scott, Ryotaro Nakamura, Wael Saber

Research output: Contribution to journalArticlepeer-review

Abstract

Comparative outcomes of allogeneic hematopoietic cell transplantation (HCT) for BCR-ABL12 myeloproliferative neoplasms (MPNs) in blast phase (MPN-BP) vs de novo acute myeloid leukemia (AML), and AML with prior myelodysplastic syndromes (MDSs; post-MDS AML), are unknown. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared HCT outcomes in 177 MPN-BP patients with 4749 patients with de novo AML, and 1104 patients with post-MDS AML, using multivariate regression analysis in 2 separate comparisons. In a multivariate Cox model, no difference in overall survival (OS) or relapse was observed in patients with MPN-BP vs de novo AML with active leukemia at HCT. Patients with MPN-BP in remission had inferior OS in comparison with de novo AML in remission (hazard ratio [HR], 1.40 [95% confidence interval [CI], 1.12-1.76]) due to higher relapse rate (HR, 2.18 [95% CI, 1.69-2.80]). MPN-BP patients had inferior OS (HR, 1.19 [95% CI, 1.00-1.43]) and increased relapse (HR, 1.60 [95% CI, 1.31-1.96]) compared with post-MDS AML. Poor-risk cytogenetics were associated with increased relapse in both comparisons. Peripheral blood grafts were associated with decreased relapse in MPN-BP and post-MDS AML (HR, 0.70 [95% CI, 0.57-0.86]). Nonrelapse mortality (NRM) was similar between MPN-BP vs de novo AML, and MPN-BP vs post-MDS AML. Total-body irradiation-based myeloablative conditioning was associated with higher NRM in both comparisons. Survival of MPN-BP after HCT is inferior to de novo AML in remission and post-MDS AML due to increased relapse. Relapse-prevention strategies are required to optimize HCT outcomes in MPN-BP.

Original languageEnglish (US)
Pages (from-to)4748-4757
Number of pages10
JournalBlood Advances
Volume4
Issue number19
DOIs
StatePublished - Oct 13 2020

All Science Journal Classification (ASJC) codes

  • Hematology

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