Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients With Acute Myeloid Leukemia Harboring KMT2A Rearrangement and Its Prognostic Factors
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Published:2024-01
Issue:
Volume:33
Page:
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ISSN:0963-6897
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Container-title:Cell Transplantation
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language:en
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Short-container-title:Cell Transplant
Author:
Jiang Bingqian1234, Zhao Yanmin1234, Luo Yi1234, Yu Jian1234, Chen Yi5, Ye Baodong6, Fu Huarui1234, Lai Xiaoyu1234, Liu Lizhen1234, Ye Yishan1234, Zheng Weiyan1234, Sun Jie1234, He Jingsong1234, Zhao Yi1234, Wei Guoqing1234, Cai Zhen1234, Huang He1234, Shi Jimin1234ORCID
Affiliation:
1. Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China 2. Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, People’s Republic of China 3. Institute of Hematology, Zhejiang University, Hangzhou, People’s Republic of China 4. Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, People’s Republic of China 5. Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Key Laboratory of Hematology, Wenzhou, People’s Republic of China 6. Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China
Abstract
KMT2A rearrangement ( KMT2A-r) in patients with acute myeloid leukemia (AML) is associated with poor outcomes; the prognostic factors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain unclear. We investigated 364 adults with AML who underwent allo-HSCT between April 2016 and May 2022, and 45 had KMT2A-r among them. Propensity score analysis with 1:1 matching and the nearest neighbor matching method identified 42 patients in KMT2A-r and non– KMT2A-r cohorts, respectively. The 2-year overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapsed mortality rates of patients with KMT2A-r ( n = 45) were 59.1%, 49.6%, 41.5%, and 8.9%, respectively. Using propensity score matching, the 2-year OS rate of patients with KMT2A-r ( n = 42) was lower than that of those without KMT2A-r ( n = 42; 56.1% vs 88.1%, P = 0.003). Among patients with KMT2A-r ( n = 45), the prognostic advantage was exhibited from transplantation in first complete remission (CR1) and measurable residual disease (MRD) negative, which was reflected in OS, RFS, and CIR ( P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, patients with AF6 had poorer outcomes than those with AF9, ELL, and other KMT2A-r subtypes ( P = 0.032, P = 0.001, and P = 0.001 for OS, RFS, and CIR, respectively). However, no differences were found in the OS, RFS, and CIR between patients with KMT2A-r with and without mutations (all P > 0.05). Univariate and multivariate analyses revealed that achieving CR1 MRD negative before HSCT was a protective factor for OS [hazard ratio (HR) = 0.242, P = 0.007], RFS (HR = 0.350, P = 0.036), and CIR (HR = 0.271, P = 0.021), while AF6 was a risk factor for RFS (HR = 2.985, P = 0.028) and CIR (HR = 4.675, P = 0.004). The prognosis of patients with KMT2A-r AML was poor, particularly those harboring AF6-related translocation; however, it is not associated with the presence of mutations. These patients can benefit from achieving CR1 MRD negative before HSCT.
Funder
National Natural Science Foundation of China
Publisher
SAGE Publications
Subject
Transplantation,Cell Biology,Biomedical Engineering
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