Prognostic factors for survival after allogeneic transplantation in acute myeloid leukemia: A censored quantile regression model

Abstract

Abstract Background: Hematopoietic stem cell transplantation is an effective treatment for several malignant and nonmalignant disorders, including hematopoietic disorders and immunological abnormalities. In adults with acute myeloid leukemia, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an appropriate therapeutic choice. In this study, we aimed to investigate prognostic factors for survival after allo-HSCT in AML patients. Methods: This historical cohort study was carried out using data from 742 adult AML patients with allo-HSCT. Data were gathered from the medical records of patients referred to Shariati Hospital, Tehran, Iran, between 2008 and 2019. Recipient age, diagnostic time to HSCT, patient and donor ABO blood group match, donor type (siblings, other relatives and unrelative), sex-matched status, disease status, and occurrence of acute graft-versus-host disease (aGVHD) were the factors considered in this study. A censored quantile regression model was used. Results: The 5-year overall survival (OS), disease-free survival (DFS), and GVHD-free relapse-free survival (GRFS) rates were 58%, 53%, and 30%, respectively. OS for recipients older than 35 years was 0.95 and 1.12 years lower than that for recipients under 35 years in the 25th and 40th percentiles, respectively. Compared with complete remission (CRΙ), the mentioned percentiles of OS for patients with CRIII disease decreased (1.72 and 3.72 years for CRIII, respectively). Additionally, the OS of ABO blood group-matched patients were 0.92 and 1.29 years greater than that of ABO major mismatch patients in the previous percentiles. patients who had relapses after HSCT have a shorter survival of 2.25 and 4.21 years, respectively. Recipient age, ABO match (major ABO mismatch), disease status, donor type and occurrence of aGVHD were significant prognostic factors for DFS. Finally, for GRFS, recipient age, sex match, disease status, donor type and occurrence of aGVHD play a role as important prognostic factors. Conclusions: Patients may live longer and have a higher quality of life if they receive a transplant when their disease is still in its early stages and they are still younger. This study may help oncologists and hematologists understand the prognostic factors of patient survival in a different range of survival to increase patients' lifetime.