Autologous or allogeneic hematopoietic stem cell transplantation as front-line treatment for adult secondary acute myeloid leukemia patients: the PETHEMA registry experience.

Autores de IIS La Fe

• Juan Serrano Gandia

  Autor

• David Martínez Cuadrón

  Autor

• Claudia Gil Sanchis

  Autor

• 

  María Ángeles Tormo Mas

  Autor

• Pablo Herrera Melian

  Autor

• Blanca Boluda Pascual

  Autor

• Pau Montesinos Fernández

  Autor

Participantes ajenos a IIS La Fe

• Bernal, Teresa
• Martinez-Sanchez, Pilar
• Rodriguez-Medina, Carlos
• Simon, Jose A Perez
• Sayas, Maria J
• Bergua, Juan
• Lavilla-Rubira, Esperanza
• Amigo, Mariluz
• Benavente, Celina
• Lorenzo, Jose L Lopez
• Perez-Encinas, Manuel M
• Vidriales, Maria B
• Aparicio-Perez, Clara
• Torres, Esther Prados de la
• Colorado, Mercedes
• de Rueda, Beatriz
• Garcia-Boyero, Raimundo
• Marini, Sandra
• Garcia-Suarez, Julio
• Lopez-Pavia, Maria
• Gomez-Roncero, Maria I
• Noriega, Victor
• Lopez, Aurelio
• Labrador, Jorge
• Cabello, Ana
• Sossa, Claudia
• Algarra, Lorenzo
• Stevenazzi, Mariana
• Torres, Laura
• Sanchez-Garcia, Joaquin
• PETHEMA Group

Grupos

• Hematología y Hemoterapia

• Infección Grave

Abstract

BACKGROUND: It is widely accepted that allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potentially curative option available for secondary Acute Myeloid Leukemia (sAML). However, clinical factors impacting outcomes after allo-HSCT and the potential role of autologous-HSCT (auto-HSCT) in real-life series are needed. Previously, the PETHEMA group reported a series of 2310 patients with sAML within the nationwide registry. Out of them, 876 were candidates to receive chemotherapy and 274 patients (55 auto-HSCT and 219 allo-HSCT). OBJECTIVE: In this work, we have analyzed the role auto-HSCT (N=55) or allo-HSCT (N=219) as front-line treatment for sAML patients included in AML Spanish PETHEMA registry. In this paper, we analyze outcomes as well as prognostic variables in this series of patients undergoing auto- or allo-HSCT as part of the front-line treatment for sAML. STUDY DESIGN: We used the multinational PETHEMA AML registry (NCT02607059) to identify adult patients (age =18 years) with a diagnosis of sAML who received auto- or allo-HSCT as front-line treatment in Spanish and Portuguese institutions from August, 1st 1992 until July, 31st 2020). Patient characteristics, diagnostic findings, and management, including treatments, characteristics of HSCT and outcomes, were retrieved from the PETHEMA AML registry in this retrospective multicenter analysis. RESULTS: With a median follow-up of 32.7 months, better 5-year OS and LFS were obtained with allo-HSCT in CR1 (44.5% and 39.9%, respectively), as compared with auto-HSCT in CR1 (30% and 20.5%, respectively) but without reaching statistical differences for OS (p= 0.22 and p=0.03). The higher incidence of relapse in auto-HSCT is counterbalanced with the significantly low NRM rate. For allo-HSCT patients, 5-year outcomes were significantly influenced by the cytogenetic/genetic risk. In multivariate analysis, adverse cytogenetic/genetic risk group retained statistical significance for all endpoints. CONCLUSION: As conclusions, we confirmed the role of allo-HSCT as a potential curative option for patients and we report that auto-HSCT in CR can still provide a 5-year LFS of 20% in sAML patients. Finally, our results confirm adverse cytogenetic/genetic risk category as an independent negative factor in sAML patients receiving HSCT.

Copyright © 2025 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Keywords

• Adults; Allo-TPH; Auto-TPH; Secondary AML