Allogeneic Hematopoietic Cell Transplantation for Adolescent and Young Adult Patients with Acute Myeloid Leukemia

Shohei Mizuno; Akiyoshi Takami; Koji Kawamura; Yasuyuki Arai; Tadakazu Kondo; Takahito Kawata; Naoyuki Uchida; Atsushi Marumo; Takahiro Fukuda; Masatsugu Tanaka; Yukiyasu Ozawa; Shuro Yoshida; Shuichi Ota; Satoru Takada; Masashi Sawa; Makoto Onizuka; Yoshinobu Kanda; Tatsuo Ichinohe; Yoshiko Atsuta; Masamitsu Yanada

doi:10.1016/j.jtct.2020.12.013

Allogeneic Hematopoietic Cell Transplantation for Adolescent and Young Adult Patients with Acute Myeloid Leukemia

Transplant Cell Ther. 2021 Apr;27(4):314.e1-314.e10. doi: 10.1016/j.jtct.2020.12.013. Epub 2021 Feb 8.

Authors

Shohei Mizuno¹, Akiyoshi Takami², Koji Kawamura³, Yasuyuki Arai⁴, Tadakazu Kondo⁴, Takahito Kawata⁵, Naoyuki Uchida⁶, Atsushi Marumo⁷, Takahiro Fukuda⁸, Masatsugu Tanaka⁹, Yukiyasu Ozawa¹⁰, Shuro Yoshida¹¹, Shuichi Ota¹², Satoru Takada¹³, Masashi Sawa¹⁴, Makoto Onizuka¹⁵, Yoshinobu Kanda¹⁶, Tatsuo Ichinohe¹⁷, Yoshiko Atsuta¹⁸, Masamitsu Yanada¹⁹

Affiliations

¹ Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan. Electronic address: [email protected].
² Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
³ Department of Hematology, Tottori University Hospital, Yonago, Japan.
⁴ Department of Hematology, Kyoto University Hospital, Kyoto, Japan.
⁵ Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
⁶ Department of Hematology, Toranomon Hospital, Tokyo, Japan.
⁷ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁸ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
⁹ Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
¹⁰ Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
¹¹ Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
¹² Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.
¹³ Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan.
¹⁴ Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan.
¹⁵ Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
¹⁶ Division of Hematology, Jichi Medical University, Simotsuke, Japan.
¹⁷ Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
¹⁸ Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹⁹ Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan.

PMID: 33836873
DOI: 10.1016/j.jtct.2020.12.013

Abstract

Limited data exist regarding the outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) among adolescent and young adult (AYA) patients with acute myeloid leukemia (AML). Here we analyzed the features and outcomes of AYA patients with AML who had achieved complete remission (CR) and those who had not (non-CR) at allo-HCT. We retrospectively analyzed 2350 AYA patients with AML who underwent allo-HCT with a myeloablative conditioning regimen and who were consecutively enrolled in the Japanese nationwide HCT registry. The difference in overall survival (OS) between younger (age 16 to 29 years) and older AYA (age 30 to 39 years) patients in CR at transplantation was not significant (70.2% versus 71.7% at 3 years; P = .62). Meanwhile, this difference trended toward a statistical significance between younger and older AYA patients in non-CR at transplantation (39.5% versus 34.3% at 3 years; P = .052). In AYA patients in CR and non-CR, the age at transplantation did not affect relapse or nonrelapse mortality (NRM). In AYA patients in CR, no difference in OS was observed between those who received total body irradiation (TBI) and those who did not (71.1% versus 70.5% at 3 years; P = .43). AYA patients who received TBI-based conditioning had a significantly lower relapse rate and higher NRM than those who underwent non-TBI-based conditioning (relapse: 19.8% versus 24.1% at 3 years [P = .047]; NRM: 14.7% versus 11.1% at 3 years [P = .021]). In contrast, among the non-CR patients, there were no differences between the TBI and non-TBI groups with respect to OS (P = .094), relapse (P = .83), and NRM (P = .27). Our data indicate that outcomes may be more favorable in younger AYA patients than in older AYA patients in non-CR at transplantation, and that outcomes of TBI-based conditioning could be comparable to those of non-TBI-based conditioning for AYA patients.

Keywords: Acute myeloid leukemia; Adolescent and young adult; Allogeneic hematopoietic cell transplantation; Myeloablative conditioning; Total body irradiation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Graft vs Host Disease*
Hematopoietic Stem Cell Transplantation*
Humans
Leukemia, Myeloid, Acute* / therapy
Retrospective Studies
Transplantation Conditioning
Young Adult