Factors predicting survival following alloSCT in patients with therapy-related AML and MDS: a multicenter study

Anmol Baranwal, Rakchha Chhetri, David Yeung, Matthew Clark, Syed Shah, Mark R. Litzow, William J. Hogan, Abhishek Mangaonkar, Hassan B. Alkhateeb, Deepak Singhal, Alia Cibich, Peter Bardy, Chung H. Kok, Devendra K. Hiwase, Mithun Vinod Shah

Research output: Contribution to journalArticlepeer-review

Abstract

Therapy-related myeloid neoplasms (t-MN) are aggressive myeloid neoplasms. Factors predicting post-allogeneic stem cell transplant (alloSCT) survival are not well-known. We studied the prognostic utility of factors at: t-MN diagnosis, pre-alloSCT, and post-alloSCT. Primary endpoints were 3-year overall survival (OS), relapse incidence (RI), and non-relapse mortality (NRM). Post-alloSCT OS did not differ between t-MDS and t-AML (20.1 vs. 19.6 months, P = 1), though t-MDS had a significantly higher 3-year RI compared to t-AML (45.1% vs. 26.9%, P = 0.03). In t-MDS, the presence of monosomy 5 (HR 3.63, P = 0.006) or monosomy 17 (HR 11.81, P = 0.01) pre-alloSCT were associated with higher RI. Complex karyotype was the only factor adversely influencing survival at all the timepoints. The inclusion of genetic information yielded 2 risk-categories: high-risk defined by the presence of pathogenic variants (PV) in (TP53/BCOR/IDH1/GATA2/BCORL1) and standard-risk (remainder of the patients) with 3-year post-alloSCT OS of 0% and 64.6%, respectively (P = 0.001). We concluded that while alloSCT was curative in a subset of t-MN patients, outcomes remained poor, specifically in the high-risk category. t-MDS patients, especially those with persistent disease pre-alloSCT were at increased risk of relapse. Disease-related factors at t-MN diagnosis were the most prognostic of post-alloSCT survival; utility of factors available later in the course, was incremental.

Original languageEnglish (US)
Pages (from-to)769-776
Number of pages8
JournalBone Marrow Transplantation
Volume58
Issue number7
DOIs
StatePublished - Jul 2023

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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