For a patient with acute myeloid leukemia (AML), minimal residual disease (MRD) status at the time of hematopoietic stem cell transplantation (HSCT) was an independent risk factor regardless of the number of remissions, according to a recent study.
Researchers retrospectively analyzed 580 patients with AML receiving HSCT between January 1999 and November 2020 in either their first (79%) or second (21%) remission.
“Due to common treatment strategies the patient cohort transplanted in second remission was enriched for favorable diagnostic risk factors, including a higher incidence of NPM1 mutations and lower incidences of monosomal or complex karyotypes, as well as secondary AML,” the researchers wrote.
Despite a higher incidence of favorable risk factors, those patients transplanted in second remission had a significantly higher cumulative incidence of relapse (CIR; P<.001) and significantly shorter recurrence-free survival (P=.002) than patients transplanted in first remission. The researchers noted that being transplanted in second remission increased the risk of relapse about threefold.
Overall survival was not significantly different between the two groups (P=.09).
Even after adjusting for European Leukemia Net (ELN) 2017 genetic risk at diagnosis, the number of remissions remained a significant prognostic factor.
In patients in first and second remission, MRD status prior to allogeneic HSCT was a significant prognostic factor for a higher CIR (P<.001) and shorter recurrence-free survival (P=.002 for first remission and P=.04 for second remission).
The researchers noted several limitations of the study including its retrospective nature and a lack of systematic MRD assessments during chemotherapy and after transplant.
Jentzsch M, Bischof L, Backhaus D, et al. Impact of the MRD status in AML patients undergoing allogeneic stem cell transplantation in first vs second remission. Blood Adv. 2022. doi:10.1182/bloodadvances.2022007168