Allogeneic hematopoietic cell transplantation for patients with acute myeloid leukemia not in remission: Japanese registry data study

Allogeneic hematopoietic cell transplantaion (HCT) is the last option for long-term survival among patients with chemotherapy-refractory acute myeloid leukemia (AML). A retrospective study using Japanese nationwide registry data analyzed outcomes of 6927 adults with AML who underwent first allogeneic HCT while not in complete remission between 2001 and 2020. The five-year rates for overall survival, relapse, and non-relapse mortality were 23%, 53%, and 27%, respectively. Multivariate analysis identified several factors predictive of overall survival mainly through their effects on relapse (cytogenetics, percentage of blasts in the peripheral blood, and transplantation year) and non-relapse mortality (age, sex, and performance status). Relapsed disease was associated with a higher risk of overall mortality than primary induction failure. The authors conclude that more than 20% of patients still have long-term survival with allogeneic HCT performed while not in complete remission.