sAML: underlying MPN tied to inferior post-transplant survival

  • Kröger N & al.
  • Br J Haematol
  • 28 Feb 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • Underlying disease plays a significant role in survival outcomes of patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT) for secondary transformed acute myeloid leukemia (sAML).

Why this matters

  • 20%-30% of myelodysplastic syndrome (MDS) cases, 15%-30% of chronic myelomonocytic leukemia (CMML) cases, and 8%-25% of myeloproliferative neoplasm (MPN) cases involve transformation to sAML, which is associated with inferior prognosis vs de novo AML.

Study design

  • Study to investigate associations between underlying disease and outcomes after allo-HSCT in 4214 patients with transformed sAML.
  • Data were sourced from the European Society for Blood and Marrow Transplantation (EBMT) database for appropriate patients who underwent allo-HSCT in 2000-2014.
  • Primary diagnosis: MDS (n=3541), CMML (n=251), MPN (n=422).
  • Median patient age, 58 (range, 18-78) years.
  • Funding: None disclosed.

Key results

  • In multivariable analyses:
    • Compared with MDS, significantly increased risk for relapse in:
      • CMML: HR, 1.47; 95% CI, 1.18-1.81; P<.001.>
      • MPN: HR, 1.59; 95% CI, 1.35-1.87; P<.001.>
    • Compared with MDS, significant effect on PFS in:
      • CMML: HR, 1.23; 95% CI, 1.05-1.45; P=.012.
      • MPN: HR, 1.3; 95% CI, 1.15-1.48; P<.001.>
    • Significantly inferior survival in MPN vs MDS: HR, 1.23; 95% CI, 1.07-1.41; P=.003.

​​​​​​​Limitations

  • Retrospective data.

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