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

Research output: Contribution to journalArticle

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.

Details

Authors
  • 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
Organisations
External organisations
  • Karolinska Institutet
  • Sahlgrenska University Hospital
  • Umeå University
  • Skåne University Hospital
  • Linköping University
  • Karolinska University Hospital
  • Uppsala University
  • South Elfsborg Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology

Keywords

  • Allogeneic hematopoietic cell transplantation, Population-based, Secondary AML, Therapy-related AML
Original languageEnglish
JournalBiology of Blood and Marrow Transplantation
Publication statusE-pub ahead of print - 2019 Jun 6
Publication categoryResearch
Peer-reviewedYes