Age and Modified European LeukemiaNet Classification to Predict Transplant Outcomes: An Integrated Approach for Acute Myelogenous Leukemia Patients Undergoing Allogeneic Stem Cell Transplantation
Published in
Biology of Blood & Marrow Transplantation, March 2015
We evaluated the prognostic significance of a modified European LeukemiaNet (ELN) classification for patients with acute myeloid leukemia (AML) undergoing hematopoietic stem cell transplantation (HSCT) while in first complete remission (CR1). We analyzed 464 AML patients with matched related (n=211, 45.5%), matched unrelated (n=176, 37.9%) and mismatched donors (n=77, 16.6%). Patients were classified into four modified ELN risk groups (favorable, intermediate-I, intermediate-II, and adverse) separately for 354 patients age <60 years and 110 patients age >=60 years. In this modified version of ELN classification, patients with normal cytogenetic were classified by FLT3-ITD mutational status; favorable risk if FLT3-ITDwild and intermediate-I if FLT3-ITDmut. The best outcomes occurred in the ELN favorable and intermediate-II groups in younger and in the favorable and intermediate-I groups in older AML patients. Older AML patients had worse transplant outcomes within each modified ELN risk group except intermediate-I when compared with younger patients; LFS at 3-year was 67.8% vs. 49.8% in favorable, 53.4% vs. 50.7% in intermediate-I, 65.7% vs. 20.2% in intermediate-II and 44.6% vs. 23.8% in adverse group younger and older patients respectively. Among lesion-specific abnormalities, del5q/-5 and abnl(17p) had the worse transplant outcomes with 3-year LFS of 18.4% and 20% in younger CR1 patients. In conclusion, the modified ELN prognostic classification developed for chemotherapy outcomes also identifies prognostic groups for HSCT, which is useful for selection of patients for post-transplant strategies to improve outcomes.
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