OUTCOMES OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ACUTE MYELOID LEUKEMIA. A SINGLE-CENTER EXPERIENCE FROM THE IAȘI REGIONAL INSTITUTE OF ONCOLOGY
DOI:
https://doi.org/10.22551/MSJ.2025.04.02Abstract
Allogeneic stem cell transplantation (allo-SCT) remains the only curative treatment option for acute myeloid leukemia (AML) patients. We present the outcomes of 59 AML patients who underwent allo-SCT at our center. Materials and methods: We retrospectively analyzed patients transplanted between 2019 and 2024. Baseline characteristics included age, sex, ELN 2022 risk, disease status at transplant (CR1, CR2, active disease), donor type, GVHD prophylaxis. Outcomes evaluated were engraftment, acute and chronic GVHD, cumulative incidence of relapse (CIR), non-relapse mortality (NRM), overall survival (OS), disease-free survival (DFS). Survival was estimated by the Kaplan-Meier method. Results: The median age was 44 years. 84.7% of patients were transplanted in CR1. Donors included: matched sibling 42.4%, unrelated 49.2%, and haploidentical 8.5%. Incidence of grade II-IV acute GVHD was 16.9%, and chronic GVHD 25.4%. At a median follow-up of 26 months (95% CI: 32-44), OS and DFS were not reached. Patients transplanted in CR1 showed the best outcomes (mean OS 88.7 months; 2-year DFS: 74%), while CR2 patients had inferior results (mean OS 33.5 months; 2-year DFS: 40-45%). Differences were significant (OS p=0.004; DFS p=0.007). Measurable residual disease at day+90 was the single most robust factor for predicting outcome in both univariate and multivariable analysis. Conclusions: Our single-center experience confirms that allo-SCT is feasible and effective in AML, with outcomes comparable to international reports. The disease status at the moment of transplantation and measurable residual disease remain the most powerful prognostic factors to identify patients at high risk of relapse.
References
1. Saeed A, Tasleem Z, Muhammad SA, et al. Economic Burden of Acute Myeloid Leukemia in European Union: Results from a Systematic Review of Literature. Pharmacoecon Open 2025; 9(3): 365.
2. Brands-Nijenhuis AVM, Labopin M, et al. Monosomal karyotype as an adverse prognostic factor in patients with acute myeloid leukemia treated with allogeneic hematopoietic stem-cell transplantation in first complete remission: A retrospective survey on behalf of the EBMT. Haematologica. 2016; 101(2): 248-255.
3. Bataller A, Kantarjian H, Bazinet A, et al. Outcomes and genetic dynamics of acute myeloid leukemia at first relapse. Haematologica 2024; 109(11): 3543-3556.
4. Sweeney C, Vyas P. The Graft-versus-Leukemia Effect in AML. Front Oncol 2019; 9: 1217.
5. Styczyński J, Tridello G, Koster L, Iacobelli S, van Biezen A, van der Werf S, et al. Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors. Bone Marrow Transplant 2020; 55(1): 126-136.
6. Döhner H, Wei AH, Appelbaum FR, Craddock C, DiNardo CD, Dombret H, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood 2022; 140(12): 1345-1377.
7. Loghavi S, Kanagal-Shamanna R, Khoury JD, et al. Fifth Edition of the World Health Classification of Tumors of the Hematopoietic and Lymphoid Tissue: Myeloid Neoplasms. Mod Pathol 2024; 37(2): 100397.
8. Vladescu C, Silvia V, Scîntee G, Olsavszky V, Hernández-Quevedo C, Sagan A. Romania: Health system review. Health systems in transition 2016; 18(6): 1-170.
9. Petre I, Barna F, Gurgus D, et al. Analysis of the Healthcare System in Romania: A Brief Review. Healthcare 2023; 11(14): 2069.
10. van Dongen JJM, Lhermitte L, Böttcher S, et al. EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia 2012; 26(9): 1908-1975.
11. Datoguia TS, Velloso EDRP, Helman R, et al. Overall survival of Brazilian acute myeloid leukemia patients according to the European Leukemia Net prognostic scoring system: a cross-sectional study. Medical Oncology 2018; 35(11): 1132-1143.
12. Benicio MT de L, Ribeiro AFT, Américo AD, et al. Evaluation of the European Leukemia Net recommendations for predicting outcomes of patients with acute myeloid leukemia treated in low- and middle-income countries (LMIC): A Brazilian experience. Leuk Res. 2017; 60: 109-114.
13. Hassanein M, Fakih R El, Rasheed W, et al. The outcomes of secondary AML post allogeneic hematopoietic cell transplantation significantly depend on the presence of poor-risk cytogenetic abnormalities. E J Haem. 2021; 2(2): 249-256.
14. Sengsayadeth S, Labopin M, Boumendil A, et al. Transplant Outcomes for Secondary Acute Myeloid Leukemia: Acute Leukemia Working Party of the European Society for Blood and Bone Marrow Transplantation Study. Biol Blood Marrow Transpl 2018; 24(7): 1406-14.
15. Saini NY, Cerny J, Furtado V, Puthawala I, et al. Hematopoeitic Cell Transplant - Comorbidity Index (HCT-CI) Score Is a Useful Tool for Predicting Induction Mortality and Overall Survival in Newly Diagnosed Acute Myeloid Leukemia Patients. Blood 2018; 132(1): 1396.
16. Aydin S, Passera R, Cerrano M, Giai V, et al. Combining the HCT-CI, G8, and AML-Score for Fitness Evaluation of Elderly Patients with Acute Myeloid Leukemia: A Single Center Analysis. Cancers (Basel) 2023; 15(4): 1002.
17. Récher C. Transplant in AML: just follow the NPM1 guide! Blood 2024; 143(19): 1881-1882.
18. Jentzsch M, Bischof L, Backhaus D, Brauer D, Schulz J, Franke GN, et al. Impact of MRD status in patients with AML undergoing allogeneic stem cell transplantation in the first vs the second remission. Blood Adv 2022; 6(15): 4570-4580.
Additional Files
Published
Issue
Section
License
Copyright (c) 2025 The Medical-Surgical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form
