Pre- and post-transplant serum albumin levels and outcomes after allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia

Hypoalbuminemia has been repeatedly linked to increased non-relapse mortality (NRM) after allogeneic hematopoietic cell transplantation (HCT); a recent analysis also suggested an association with relapse risk. To evaluate the relationship between hypoalbuminemia, NRM, and relapse, we assessed its prognostic role in 1258 adults with MDS (myelodysplastic neoplasm)/AML or AML allografted while in remission between 2006 and 2023. After multivariable adjustment, low pre-HCT serum albumin levels were statistically significantly associated with NRM (hazard ratio HR = 0.67, p = 0.028), relapse-free survival (RFS; HR = 0.73, p = 0.005), and overall survival (OS; HR = 0.72, p = 0.007) but not relapse (HR = 0.77, p = 0.070). A day-28 landmark analysis showed day +28 hypoalbuminemia to be associated with NRM (HR = 0.31, p < 0.001), RFS (HR = 0.67, p < 0.001), and OS (HR = 0.52, p < 0.001) but not relapse (HR = 1.08, p = 0.6). Together, our data indicate that pre- and post-HCT serum albumin levels are independently associated with NRM and survival in AML patients undergoing allogeneic HCT.