Clinical features and prognostic nomogram for therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation
Menglin Li, Yimeng Li, Qingyuan Qu, Chen‐Cong Wang, Qi Chen, Xiaolu Zhu, Yun He, Hai‐Xia Fu, Yuanyuan Zhang, Hao Jiang, Qian Jiang, Xiaosu Zhao, Xiangyu Zhao, Yingjun Chang, Feng‐Rong Wang, Xiao‐Dong Mo, Wei Han, Jingzhi Wang, Huan Chen, Yuhong Chen, Yao Chen, Yu Wang, Lan-Ping Xu, Kai‐Yan Liu, Xiaojun Huang, Xiaohui Zhang
Abstract
Therapy-related acute myeloid leukemia (t-AML), which develops after cytotoxic therapy, has a poorer prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential cure, its efficacy varies among patients. In this retrospective study, we analyzed 154 patients with t-AML who underwent hematopoietic stem cell transplantation (HSCT) at our institution to determine their clinical characteristics and develop a prognostic nomogram. The median ages at t-AML diagnosis prior disease diagnosis was 42 and 39 years, respectively. Multivariate analysis identified key prognostic indicators: leukocyte count at AML diagnosis ≥ 7 × 10ˆ9/L, genetic abnormalities before HSCT, platelet engraftment ≥ 28 days, age at prior disease ≥ 45 years, and relapse of prior disease. We developed a prognostic nomogram for LGPAR by categorizing patients into low, medium, and high-risk groups. The 3-year and 5-year overall survival (OS) rates for these groups were 92.6%, 84.4%, 14%, and 92.6%, 76.6%, and 7%, respectively. The 3-year and 5-year relapse-free survival (RFS) rates were 80%, 75.9%, 10.7% and 80%, 72.6%, and 10.7% for the respective risk groups. The 3-year and 5-year non-relapse mortality (NRM) rates were 0%, 5.6%, 63.3% and 0%, 9.3%, and 63.3% for these groups, respectively. This novel prognostic nomogram culminates in the development of a clinical decision-support tool for patients with t-AML undergoing allo-HSCT. • The new LGPAR nomogram can better predict outcomes for t-AML patients following HSCT • Delayed platelet engraftment is an important prognostic risk factor • Genetic abnormalities before HSCT connects to worse survival • Older age and recurrent of prior disease are independent risk factors • Early HSCT following gene negative and platelet engrafment may improve survival