Comparison of Outcomes of Allogeneic Hematopoietic Cell Transplantation in Patients with Acute Myeloid Leukemia (AML) with Antecedent History of Philadelphia-Negative Myeloproliferative Neoplasm with De Novo AML and with AML Arising from Myelodysplastic Syndrome: A Study from the Center for International Blood and Marrow Transplant Research (CIBMTR)

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the only treatment modality associated with long-term disease control in patients with acute myeloid leukemia (AML) with antecedent history of Myeloproliferative neoplasms (MPN), however outcomes data are scanty. We compared the outcomes of 177 patients with AML with prior MPN (post MPN AML) with 4749 patients with de no AML, and 1104 patients with AML with prior myelodysplastic syndrome (Post MDS AML) with an aim to identify patient, disease and transplant related factors associated with outcomes. The study cohort included patients aged ≥ 40 years undergoing first HCT between 2001 and 2015. Patients with Philadelphia or BCR-ABL positive MPN, undergoing transplants from syngeneic donors, cord blood transplants, or ex vivo T-cell depletion were excluded. Comparisons of outcomes of HCT were done in post MPN AML versus de novo AML and post MPN AML versus post MDS AML using multivariate regression analysis. A higher proportion of patients with post MPN AML had monosomal or non-monosomal poor risk karyotype (39%) in comparison to de novo AML (23%) and post MDS AML (34%). Active leukemia at HCT was seen in 52%, 26% and 42% in patients with post MPN AML, de novo AML and post MDS AML, respectively. In multivariate cox model, patients with post MPN AML in morphological leukemia free state (blasts Patients with post MPN AML are at high risk of relapse compared to de novo AML and post MDS AML. Peripheral blood grafts result in lower relapse risk in patients with post MPN and post MDS AML. Relapse prevention strategies are required to optimize the outcomes of HCT in post MPN AML.