A study presented at the 62nd ASH Annual Meeting & Exposition demonstrated that allogeneic hematopoietic cell transplantation (alloHCT) has provided much better survival outcomes over the past few decades for patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS).
AlloHCT is very important in post-remission therapy for AML, and it is the only curative option for patients with relapsed or refractory AML or those with high-risk MDS, according to the research team, led by Audrey M. Sigmund, MD, of the Division of Hematology in the Department of Internal Medicine at Ohio State University in Columbus.
But there are obstacles to its successful use, such as:
- Risk for relapse
- Graft-versus-host disease (GVHD)
- Infection
The research team sought to determine whether survival rates have improved over time with improved transplant conditioning regimens, supportive care, and earlier recognition of complications. They examined data from 900 consecutive patients (705 with AML and 195 with MDS) who received an alloHCT at their institution from 1984 to 2018. They analyzed progression-free survival (PFS) and overall survival (OS) to identify any trends. They also studied incidence of GVHD and non-relapse mortality (NRM).
The study found improvements in both survival measurements since 1984. The five-year PFS rate improved from 17% in the earliest treatment group to 49% in the most recent treatment group. The five-year OS rate went from 17% in the earliest treatment group to 53% in the most recent treatment group. The rate of NRM also significantly improved, with rates of one-year NRM dropping from 31% to 15% and five-year NRM dropping from 45% to 21%. However, rates of GVHD appeared to fluctuate and sometimes increase over the years.
“Major factors that likely contribute to improvement in outcomes throughout the years include adjustments in conditioning regimens and GVHD prophylaxis, earlier recognition of complications as well as improved management, and improved general supportive care,” the researchers said. “Overall, while outcomes have improved significantly throughout the years, post-transplant relapses remain the leading cause of transplant failure in this group. Preventing relapse post-transplant represents a continued target for research today.”