Improvements in Posttransplant Outcomes Over Two Decades in Older Patients with Acute Myeloid Leukemia in the EBMT ALWP Study
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Improvements in Posttransplant Outcomes Over Two Decades in Older Patients with Acute Myeloid Leukemia in the EBMT ALWP Study. / Bazarbachi, Ali; Labopin, Myriam; Moukalled, Nour; Kröger, Nicolaus; Rautenberg, Christina; Schetelig, Johannes; Finke, Jürgen; Blau, Igor Wolfgang; Blaise, Didier; Stelljes, Matthias; Eder, Matthias; Platzbecker, Uwe; Dreger, Peter; Bethge, Wolfgang; Tischer, Johanna; Burns, David; Sengeloev, Henrik; Brissot, Eolia; Giebel, Sebastian; Nagler, Arnon; Ciceri, Fabio; Mohty, Mohamad.
in: CLIN CANCER RES, Jahrgang 30, Nr. 9, 01.05.2024, S. 1778-1787.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Improvements in Posttransplant Outcomes Over Two Decades in Older Patients with Acute Myeloid Leukemia in the EBMT ALWP Study
AU - Bazarbachi, Ali
AU - Labopin, Myriam
AU - Moukalled, Nour
AU - Kröger, Nicolaus
AU - Rautenberg, Christina
AU - Schetelig, Johannes
AU - Finke, Jürgen
AU - Blau, Igor Wolfgang
AU - Blaise, Didier
AU - Stelljes, Matthias
AU - Eder, Matthias
AU - Platzbecker, Uwe
AU - Dreger, Peter
AU - Bethge, Wolfgang
AU - Tischer, Johanna
AU - Burns, David
AU - Sengeloev, Henrik
AU - Brissot, Eolia
AU - Giebel, Sebastian
AU - Nagler, Arnon
AU - Ciceri, Fabio
AU - Mohty, Mohamad
N1 - ©2024 American Association for Cancer Research.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - PURPOSE: Acute myeloid leukemia (AML) is a disease of older patients. Progress in allogeneic hematopoietic cell transplantation (allo-HCT) allowed the delivery of allo-HCT to older patients. We assessed changes over time in transplant characteristics and outcomes in patients with AML ages 65 years and above.PATIENTS AND METHODS: We identified 7,215 patients with AML (median age 68 years, range 65-80) allografted between 2000 and 2021 in first complete remission (CR1; 64%), second or subsequent remission (CR2+; 14%), or active disease (22%).RESULTS: Median follow-up was 40 months. The 3-year cumulative relapse incidence (RI) gradually and significantly decreased from 37% to 31%, then to 30% (P = 0.001) over the three time periods (2000-2009; 2010-2014; 2015-2021), whereas nonrelapse mortality (NRM) decreased from 31% and 31% to 27% (P = 0.003). The 3-year leukemia-free survival (LFS) and overall survival (OS) gradually and significantly improved from 32% to 38%, and then to 44% (P = 0.001) and from 37% to 42%, and then to 49% (P = 0.001), respectively. In multivariate analysis, significant improvement in the RI, LFS, and OS were noted after 2015, whereas NRM was not significantly affected. This improvement was observed regardless of disease status at transplant.CONCLUSIONS: In older patients with AML, we observed an impressive improvement over time in posttransplant outcomes, mostly attributed to decreased RI rather than decreased NRM, and regardless of disease status at transplant. These large-scale, real-world data can serve as a benchmark for future studies in this setting and indicate that the opportunity for transplant for the elderly should be mandatory and no longer an option.
AB - PURPOSE: Acute myeloid leukemia (AML) is a disease of older patients. Progress in allogeneic hematopoietic cell transplantation (allo-HCT) allowed the delivery of allo-HCT to older patients. We assessed changes over time in transplant characteristics and outcomes in patients with AML ages 65 years and above.PATIENTS AND METHODS: We identified 7,215 patients with AML (median age 68 years, range 65-80) allografted between 2000 and 2021 in first complete remission (CR1; 64%), second or subsequent remission (CR2+; 14%), or active disease (22%).RESULTS: Median follow-up was 40 months. The 3-year cumulative relapse incidence (RI) gradually and significantly decreased from 37% to 31%, then to 30% (P = 0.001) over the three time periods (2000-2009; 2010-2014; 2015-2021), whereas nonrelapse mortality (NRM) decreased from 31% and 31% to 27% (P = 0.003). The 3-year leukemia-free survival (LFS) and overall survival (OS) gradually and significantly improved from 32% to 38%, and then to 44% (P = 0.001) and from 37% to 42%, and then to 49% (P = 0.001), respectively. In multivariate analysis, significant improvement in the RI, LFS, and OS were noted after 2015, whereas NRM was not significantly affected. This improvement was observed regardless of disease status at transplant.CONCLUSIONS: In older patients with AML, we observed an impressive improvement over time in posttransplant outcomes, mostly attributed to decreased RI rather than decreased NRM, and regardless of disease status at transplant. These large-scale, real-world data can serve as a benchmark for future studies in this setting and indicate that the opportunity for transplant for the elderly should be mandatory and no longer an option.
U2 - 10.1158/1078-0432.CCR-23-3673
DO - 10.1158/1078-0432.CCR-23-3673
M3 - SCORING: Journal article
C2 - 38514469
VL - 30
SP - 1778
EP - 1787
JO - CLIN CANCER RES
JF - CLIN CANCER RES
SN - 1078-0432
IS - 9
ER -