A recent study assessed outcomes for patients with acute myeloid leukemia with multilineage dysplasia (AML-MLD) who received allogeneic hematopoietic cell transplantation (HCT) with or without prior induction chemotherapy. Results were published in the American Journal of Hematology.
In this retrospective analysis of 1445 patients with AML-MLD who underwent allogeneic HCT in Japan between 2007 and 2016, transplant outcomes were compared primarily between 2 cohorts of propensity-matched patients. Each cohort included 269 patients and one cohort had received upfront HCT while the other had received induction chemotherapy before HCT.
Overall survival (OS) did not significantly differ between the cohorts, with a 3-year OS rate of 38% (95% CI, 32%-44%) for patients who received upfront HCT and 37% (95% CI, 31%-43%; P =.732) for patients who received induction chemotherapy prior to HCT.
Upfront HCT was significantly associated with lower cumulative incidence of leukemia-related mortality among all propensity-matched patients (P =.001) and among several poorer-risk patient subgroups. These included patients with poor cytogenetics (P =.02), patients with lower white blood cell counts (P =.01), patients aged between 60 and 70 years (P =.025), and patients treated with myeloablative conditioning (P =.002) or unrelated cord blood transplantation (P =.042).
Among propensity-matched patients who died, those who received pre-HCT induction chemotherapy most commonly died from relapse (73/170 deaths), while infection was the most common cause of mortality (45/166 deaths) among those given upfront HCT.
The authors concluded that among patients with AML-MLD, pre-HCT induction chemotherapy was not beneficial for survival compared with upfront HCT, leading them to recommend consideration of upfront HCT for eligible patients.
1. Konuma T, Harada K, Yamasaki S, et al. Upfront allogeneic hematopoietic cell transplantation (HCT) versus remission induction chemotherapy followed by allogeneic HCT for acute myeloid leukemia with multilineage dysplasia: a propensity score matched analysis [published online October 29, 2018]. Am J Hematol. doi: 10.1002/ajh.25336