Long-term survival after allogeneic stem cell transplantation in patients with acute myeloid leukemia

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment for patients with higher-risk acute myeloid leukemia (AML), but survival is limited by recurrent malignancy and complications such as organ toxicity and infections. This study evaluated overall survival (OS) over the last two decades in a national cohort of 1,112 adult AML patients (49% female, median age 51 years, 63% unrelated donors) receiving comparable conditioning regimens, supportive care, and using comparable donor selection criteria between 2000 and 2017. Outcome parameters were compared across three time periods: 2000–2005, 2006–2011, and 2012–2017.We observed significant changes in patient characteristics, including older age, higher rates of first complete remission at HCT, and increasing use of unrelated donors and peripheral blood stem cells over time. Five-year OS was 38%, 45%, and 35% respectively in the three time periods. Estimated overall non-relapse mortality and relapse rate was 27% and 37%. In patients with active disease at HCT, OS increased from 15% to 28% ( p  = 0.082) and relapse incidence was 58%, 40% and 54% respectively ( p  = 0.016). Survival outcomes for AML patients undergoing allogeneic HCT showed trends to improvement over the past two decades, with key clinical factors influencing prognosis.