Homoharringtonine-based induction therapy is associated with a reduced recurrence rate in pediatric patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT), according to research published in Cell Transplantation.
Researchers conducted a retrospective study of pediatric patients diagnosed with AML from August 2015 to October 2019 and treated with HSCT at a single center. The primary objective was to evaluate cumulative recurrence rate (CRR); overall survival (OS) and risk factors associated with recurrence were also assessed.
A total of 37 patients (median age, 6.00 years; range, 3.00-10.50; 70.27% male) were included in the analysis. The median follow-up time after HSCT was 37.00 months (range, 11.0-45.50). By the last follow up, 75.7% of the patients were alive, and 24.3% of patients had died.
Kaplan-Meier estimates for the OS rates were 89.2±5.1%, 75.7±7.1%, and 75.7±7.1% at 1, 3, and 5 years after HSCT, respectively, and for the CRRs were 11.4±5.4%, 24.7±7.7%, and 33.1±10.4% at 1, 3, and 5 years after HSCT, respectively. Of 9 children (24.3%) with relapse after transplantation, 4 (44.4%) died.
The analysis showed that homoharringtonine-based induction therapy (vs etoposide-based induction therapy) was associated with a low recurrence rate after adjusting for age, sex, risk stratification, fusion genes, and fungal infections (adjusted hazard ratio, 0.093; 95% CI, 0.009-0.920; P =.042).
“As treatment-related toxicity and mortality continue to improve, relapse has become the most important cause of treatment failure, and new approaches are needed to make the next large leap forward in transplantation for AML,” the authors wrote in their report. “It is worth noting that up to 44.4% of deaths were attributed to leukemia, which highlights how difficult it is to manage AML once patients have developed post-transplant relapse.”
The primary limitations of the study were the small sample size and single-center design.
Wang B, Wen X, Zhang R, et al. Homoharringtonine-based induction therapy reduces the recurrence rate of pediatric acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. Cell Transplant. 2023;32:9636897231183559. doi:10.1177/09636897231183559