Personalized prediction of overall survival in patients with AML in non‐complete remission undergoing allo‐HCT

Cancer Medicine

Ryuji Uozumi¹  Naoyuki Uchida²  Tetsuya Eto³  Masatsugu Tanaka⁴  Masamitsu Yanada⁵  Yasuyuki Arai⁶  Takahito Kawata⁶  Junya Kanda⁶  Shigeki Hirabayashi⁶  Tadakazu Kondo⁶  Tatsuo Ichinohe⁷  Atsushi Wake⁸  Takahiro Fukuda⁹  Ken Tabuchi^1,10  Shingo Yano^1,11  Kazuhiro Ikegame^1,12  Atsushi Marumo^1,13  Yoshiko Atsuta^1,14  Takafumi Kimura^1,15 

[1] Department of Biomedical Statistics and Bioinformatics Kyoto University Graduate School of Medicine Kyoto Japan;Department of Hematology Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Tokyo Japan;Department of Hematology Hamanomachi Hospital Fukuoka Japan;Department of Hematology Kanagawa Cancer Center Yokohama Japan;Department of Hematology and Cell Therapy Aichi Cancer Center Nagoya Japan;Department of Hematology and Oncology Kyoto University Graduate School of Medicine Kyoto Japan;Department of Hematology and Oncology Research Institute for Radiation Biology and Medicine, Hiroshima University Hiroshima Japan;Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Kajigaya Kawasaki Japan;Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan;Department of Pediatrics Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital Tokyo Japan;Division of Clinical Oncology and Hematology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan;Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Japan;Hematology Division Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital Tokyo Japan;Japanese Data Center for Hematopoietic Cell Transplantation Nagoya Japan;Preparation Department Japanese Red Cross Kinki Block Blood Center Osaka Japan;

关键词: acute myeloid leukemia;    hematopoietic stem cell transplantation;    nomogram;    non‐complete remission;    web application;   

DOI  :  10.1002/cam4.3920

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown