Division of Hematology Oncology, Department of Medicine
Hematology | Hemic and Lymphatic Diseases | Neoplasms | Oncology | Therapeutics
Comparative outcomes of allogeneic hematopoietic cell transplantation (HCT) for BCR-ABL1- myeloproliferative neoplasms (MPNs) in blast phase (MPN-BP) vs de novo acute myeloid leukemia (AML), and AML with prior myelodysplastic syndromes (MDSs; post-MDS AML), are unknown. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared HCT outcomes in 177 MPN-BP patients with 4749 patients with de novo AML, and 1104 patients with post-MDS AML, using multivariate regression analysis in 2 separate comparisons. In a multivariate Cox model, no difference in overall survival (OS) or relapse was observed in patients with MPN-BP vs de novo AML with active leukemia at HCT. Patients with MPN-BP in remission had inferior OS in comparison with de novo AML in remission (hazard ratio [HR], 1.40 [95% confidence interval [CI], 1.12-1.76]) due to higher relapse rate (HR, 2.18 [95% CI, 1.69-2.80]). MPN-BP patients had inferior OS (HR, 1.19 [95% CI, 1.00-1.43]) and increased relapse (HR, 1.60 [95% CI, 1.31-1.96]) compared with post-MDS AML. Poor-risk cytogenetics were associated with increased relapse in both comparisons. Peripheral blood grafts were associated with decreased relapse in MPN-BP and post-MDS AML (HR, 0.70 [95% CI, 0.57-0.86]). Nonrelapse mortality (NRM) was similar between MPN-BP vs de novo AML, and MPN-BP vs post-MDS AML. Total-body irradiation-based myeloablative conditioning was associated with higher NRM in both comparisons. Survival of MPN-BP after HCT is inferior to de novo AML in remission and post-MDS AML due to increased relapse. Relapse-prevention strategies are required to optimize HCT outcomes in MPN-BP.
hematopoietic cell transplantation, acute myeloid leukemia, BCR-ABL1- myeloproliferative neoplasms, transplantation
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DOI of Published Version
Gupta V, Kim S, Hu ZH, Liu Y, Aljurf M, Bacher U, Beitinjaneh A, Cahn JY, Cerny J, Copelan E, Gadalla SM, Gale RP, Ganguly S, George B, Gerds AT, Gergis U, Hamilton BK, Hashmi S, Hildebrandt GC, Kamble RT, Kindwall-Keller T, Lazarus HM, Liesveld JL, Litzow M, Maziarz RT, Nishihori T, Olsson RF, Rizzieri D, Savani BN, Seo S, Solh M, Szer J, Verdonck LF, Wirk B, Woolfrey A, Yared JA, Alyea EP, Popat UR, Sobecks RM, Scott BL, Nakamura R, Saber W. Comparison of outcomes of HCT in blast phase of BCR-ABL1- MPN with de novo AML and with AML following MDS. Blood Adv. 2020 Oct 13;4(19):4748-4757. doi: 10.1182/bloodadvances.2020002621. PMID: 33007075; PMCID: PMC7556156. Link to article on publisher's site
Gupta V, Cerny J. (2020). Comparison of outcomes of HCT in blast phase of BCR-ABL1- MPN with de novo AML and with AML following MDS. Open Access Publications by UMMS Authors. https://doi.org/10.1182/bloodadvances.2020002621. Retrieved from https://escholarship.umassmed.edu/oapubs/4387