Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting

Christer Nilsson; Erik Hulegårdh; Hege Garelius; Lars Möllgård; Mats Brune; Anders Wahlin; Stig Lenhoff; Ulla Frödin; Mats Remberger; Martin Höglund; Gunnar Juliusson; Dick Stockelberg; Sören Lehmann

doi:10.1016/j.bbmt.2019.05.038

Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting

Biol Blood Marrow Transplant. 2019 Sep;25(9):1770-1778. doi: 10.1016/j.bbmt.2019.05.038. Epub 2019 Jun 6.

Authors

Affiliations

¹ Division of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden. Electronic address: christer.nilsson@ki.se.
² Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
³ Department of Radiation Sciences, University of Umeå, Umeå, Sweden.
⁴ Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
⁵ Departments of Hematology and Medical and Health Sciences, Linköping University, Linköping, Sweden.
⁶ Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
⁷ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁸ Department of Medicine and Oncology, Södra Älvsborgs Hospital, Borås, Sweden.
⁹ Division of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

PMID: 31176789
DOI: 10.1016/j.bbmt.2019.05.038

Abstract

Secondary AML (s-AML), including AML with an antecedent hematologic disorder (AHD-AML) and therapy-related AML (t-AML), constitutes a large proportion of patients with AML and is considered to confer a dismal prognosis. The role of allogeneic hematopoietic cell transplantation (HCT) in patients with s-AML and the extent to which HCT is performed in these patients has been little studied to date. We used the population-based Swedish AML Registry comprising 3337 intensively treated adult patients over a 17-year period to study the role of HCT within the group of patients with s-AML as well as compared with patients with de novo AML. HCT was performed in 576 patients (22%) with de novo AML, in 74 patients (17%) with AHD-AML, and in 57 patients (20%) with t-AML. At 5 years after diagnosis, there were no survivors among patients with previous myeloproliferative neoplasms who did not undergo HCT, and corresponding survival for patients with antecedent myelodysplastic syndromes and t-AML was and 2% and 4%, respectively. HCT was compared with chemotherapy consolidation in s-AML using 3 models: (1) a 200-day landmark analysis, in which HCT was favorable compared with conventional consolidation (P = .04, log-rank test); (2) a multivariable Cox regression with HCT as a time-dependent variable, in which the hazard ratio for mortality was 0.73 (95% confidence interval, 0.64 to 0.83) for HCT and favored HCT in all subgroups; and (3) a propensity score matching analysis, in which the 5-year overall survival (OS) and relapse-free survival in patients with s-AML in first complete remission (CR1) was 48% and 43%, respectively, for patients undergoing HCT versus 20% and 21%, respectively, for those receiving chemotherapy consolidation (P = .01 and .02, respectively, log-rank test). Our observational data suggest that HCT improves survival and offers the only realistic curative treatment option in patients with s-AML.

Keywords: Allogeneic hematopoietic cell transplantation; Population-based; Secondary AML; Therapy-related AML.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Allografts
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation*
Humans
Leukemia, Myeloid, Acute* / mortality
Leukemia, Myeloid, Acute* / therapy
Male
Middle Aged
Retrospective Studies
Survival Rate
Time Factors