Abstract Allogeneic hematopoietic cell transplantation (allo-HCT) following complete remission (CR) after induction chemotherapy has traditionally been the only curative approach for high-risk acute myeloid leukemia (AML). Recent advances have expanded allo-HCT eligibility to older patients. However, the requirement of achieving CR before transplant is increasingly being challenged. We retrospectively analyzed outcomes of 106 AML patients who underwent allo-HCT between 2010 and 2023 at our center, regardless of remission status. Patients received either hypomethylating agents (HMA, n = 42), HMA plus venetoclax (HMA + Ven, n = 24), or no prior therapy (upfront, n = 40). CR at the time of transplant was achieved in 19% of HMA and 38% of HMA + Ven patients. One-year non-relapse mortality (NRM) was significantly higher in the HMA group (26.2%) compared to HMA + Ven (4.2%, p = 0.0062) and upfront (5.0%, p = 0.0061) groups. However, the one-year cumulative incidence of relapse was similar across cohorts (HMA 19.1%, HMA + Ven 16.7%, upfront 15.0%). Three-year overall survival was 47.6% (HMA), 61.7% (HMA + Ven), and 71.8% (upfront). These findings support the feasibility of allo-HCT in AML patients treated with low-intensity pretransplant regimens, even without prior CR, and highlight the need for prospective trials to to avoid excluding patients with active disease from potentially curative options.
Wehr et al. (Wed,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: