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Conditioning Intensity Before Transplantation May Affect Outcomes in AML

By: Cordi Craig
Posted: Monday, April 13, 2020

Even after receiving allogeneic hematopoietic cell transplantation, patients with acute myeloid leukemia (AML) who are in remission remain at risk for relapse. However, Mitchell E. Horwitz, MD, of Duke University, Durham, North Carolina, and colleagues posited that adjusting the intensity of allogeneic conditioning may affect relapse and survival rates. The study results, published in the Journal of Clinical Oncology, suggest that myeloablative conditioning in patients with AML who test positive for measurable residual disease prior to allogeneic hematopoietic cell transplantation achieve better survival outcomes than those given reduced-intensity conditioning.

The researchers performed ultra-deep sequencing for 13 commonly mutated genes in AML on preconditioned blood from patients treated in a phase III clinical trial. The trial included patients with AML who were in morphologic complete remission who were assigned to receive myeloablative or reduced-intensity conditioning.

The research team did not detect any mutations in 32% of the myeloablative group and 37% of the reduced-intensity group. Patients without detectable mutations in the two groups had similar survival rates. Those patients in the myeloablative conditioning group had a 3-year survival rate of 56% versus 63% in the reduced-intensity group (P = .96).

However, relapse and survival rates were significantly different between the two groups among patients with detectable mutations. Patients in the myeloablative group with detectable mutations had a relapse rate of 19% versus 67% in the reduced-intensity group (P < .001). Survival was also significantly longer in the myeloablative group than in the reduced-intensity group (61% vs. 43%; P = .02). The investigators found that, for patients who tested positive for mutations, reduced-intensity conditioning was associated with increased rates of relapse (P < 001), lower relapse-free survival (P < .001), and lower overall survival (P = .01) than similar patients in the myeloablative group.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.



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