Allogeneic stem cell transplant in patients with acute myeloid leukemia and karnofsky performance status score less than or equal to 80%: A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation (EBMT)

Francesco Saraceni, Myriam Labopin, Edouard Forcade, Nicolaus Kröger, Gerard Socié, Riitta Niittyvuopio, Jan J Cornelissen, Hélène Labussière-Wallet, Didier Blaise, Goda Choi, Jenny L Byrne, Gaelle Guillerm, Tony Marchand, Jordi Esteve, Ali Bazarbachi, Bipin Savani, Attilio Olivieri, Arnon Nagler, Mohamad Mohty

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    Abstract

    Limited data are currently available on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) with a reduced performance status. We herein present the results of a registry study on 2,936 AML patients undergoing allo-SCT in first remission (CR1) with a Karnofsky Performance Status (KPS) score less than or equal to 80%. Two-year leukemia-free survival (LFS), overall survival (OS) and graft-versus-host disease (GVHD)-free, and relapse-free survival (GRFS) rates were 54%, 59%, and 41%, respectively. In multivariable analysis, patients with a KPS score = 80% had lower non-relapse mortality (NRM) and superior OS in comparison to patients with a KPS score <80% (p < 0.001). In the subgroup of patients with a KPS score =80%, a reduced-intensity conditioning (RIC) regimen was associated with an increased risk of relapse (p = 0.002) and lower GRFS (p < 0.001) compared to myeloablative conditioning (MAC). Differently, in patients with a KPS score <80%, a RIC regimen resulted in lower NRM (p < 0.001), whereas relapse incidence did not differ, thus leading to an improved GRFS (p = 0.008) as compared to MAC. A transplant from a matched sibling donor (MSD) was associated with a reduced incidence of grade III-IV acute GVHD (p < 0.01) and NRM (p < 0.01) in comparison to other donor types. In conclusion, allo-SCT appears feasible in AML patients with a jeopardized KPS score. Survival is significantly affected by the conditioning intensity, which should be adjusted according to the severity of KPS impairment.

    Original languageEnglish
    Pages (from-to)23-33
    Number of pages11
    JournalCancer medicine
    Issue number1
    Early online date26-Nov-2020
    DOIs
    Publication statusPublished - 26-Nov-2020

    Keywords

    • acute myeloid leukemia
    • allogeneic stem cell transplant
    • karnofsky performance status score
    • myeloablative conditioning
    • reduced intensity conditioning
    • 1ST COMPLETE REMISSION
    • MYELODYSPLASTIC SYNDROMES
    • PREPARATIVE REGIMENS
    • COMORBIDITY INDEX
    • RISK-ASSESSMENT
    • INTENSITY
    • MORTALITY
    • MULTICENTER
    • AGE
    • FLUDARABINE

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