Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience
BackgroundAllogeneic stem cell transplant (allo-SCT) plays a key role in the treatment of patients with both acute myeloid leukemia (AML) and myelodysplastic (MDS). Outcomes of allo-SCT have improved with optimization of transplant practices. We sought to evaluate trends in survival in AML and MDS p...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Hematology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frhem.2023.1274649/full |
| _version_ | 1797667800375885824 |
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| author | Audrey M. Sigmund Justin Jiang Qiuhong Zhao Patrick Elder Don M. Benson Sumithira Vasu Samantha Jaglowski Alice S. Mims Hannah Choe Karilyn Larkin Jonathan E. Brammer Sarah A. Wall Nicole Grieselhuber William Basem Sam Penza Yvonne A. Efebera Nidhi Sharma |
| author_facet | Audrey M. Sigmund Justin Jiang Qiuhong Zhao Patrick Elder Don M. Benson Sumithira Vasu Samantha Jaglowski Alice S. Mims Hannah Choe Karilyn Larkin Jonathan E. Brammer Sarah A. Wall Nicole Grieselhuber William Basem Sam Penza Yvonne A. Efebera Nidhi Sharma |
| author_sort | Audrey M. Sigmund |
| collection | DOAJ |
| description | BackgroundAllogeneic stem cell transplant (allo-SCT) plays a key role in the treatment of patients with both acute myeloid leukemia (AML) and myelodysplastic (MDS). Outcomes of allo-SCT have improved with optimization of transplant practices. We sought to evaluate trends in survival in AML and MDS patients undergoing allo-SCT at our institution from 1984 to 2018.MethodsA retrospective analysis of 900 consecutive AML and MDS patients undergoing allo-SCT was performed. Patients were divided by year of transplant for analysis. Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints included non-relapse mortality (NRM), graft-versus-host disease (GVHD), GVHD-free relapse free survival (GRFS), and transplant complications.ResultsWe found a significant improvement in survival from 1984 to 2018 with 5-year PFS and OS improving from 17% to 49% and 17% to 53%, respectively (statistically significant difference since 2004; p<0.001). There was a significant difference in rates of grade II-IV aGVHD (p<0.001) and chronic GVHD at day +365 with cumulative incidence of both highest from 2014-2018, however, NRM improved across the years with 5- year NRM decreasing from 45% to 21%. Rates of pulmonary infections, hemorrhagic cystitis, veno-occlusive disease, and fungal infections also decreased across the years (p<0.001).ConclusionsWe found a significant improvement in survival of AML and MDS patients undergoing allo-HCT over the past several decades. This likely reflects improvements in transplant practices and general supportive care. Post-transplant relapse remains the leading cause of transplant failure in this group. |
| first_indexed | 2024-03-11T20:19:47Z |
| format | Article |
| id | doaj.art-c65f2ecfcdca40aaa0df82a9fc6077a5 |
| institution | Directory Open Access Journal |
| issn | 2813-3935 |
| language | English |
| last_indexed | 2024-03-11T20:19:47Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Hematology |
| spelling | doaj.art-c65f2ecfcdca40aaa0df82a9fc6077a52023-10-03T09:08:33ZengFrontiers Media S.A.Frontiers in Hematology2813-39352023-10-01210.3389/frhem.2023.12746491274649Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experienceAudrey M. Sigmund0Justin Jiang1Qiuhong Zhao2Patrick Elder3Don M. Benson4Sumithira Vasu5Samantha Jaglowski6Alice S. Mims7Hannah Choe8Karilyn Larkin9Jonathan E. Brammer10Sarah A. Wall11Nicole Grieselhuber12William Basem13Sam Penza14Yvonne A. Efebera15Nidhi Sharma16Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesCollege of Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesDivision of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United StatesBackgroundAllogeneic stem cell transplant (allo-SCT) plays a key role in the treatment of patients with both acute myeloid leukemia (AML) and myelodysplastic (MDS). Outcomes of allo-SCT have improved with optimization of transplant practices. We sought to evaluate trends in survival in AML and MDS patients undergoing allo-SCT at our institution from 1984 to 2018.MethodsA retrospective analysis of 900 consecutive AML and MDS patients undergoing allo-SCT was performed. Patients were divided by year of transplant for analysis. Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints included non-relapse mortality (NRM), graft-versus-host disease (GVHD), GVHD-free relapse free survival (GRFS), and transplant complications.ResultsWe found a significant improvement in survival from 1984 to 2018 with 5-year PFS and OS improving from 17% to 49% and 17% to 53%, respectively (statistically significant difference since 2004; p<0.001). There was a significant difference in rates of grade II-IV aGVHD (p<0.001) and chronic GVHD at day +365 with cumulative incidence of both highest from 2014-2018, however, NRM improved across the years with 5- year NRM decreasing from 45% to 21%. Rates of pulmonary infections, hemorrhagic cystitis, veno-occlusive disease, and fungal infections also decreased across the years (p<0.001).ConclusionsWe found a significant improvement in survival of AML and MDS patients undergoing allo-HCT over the past several decades. This likely reflects improvements in transplant practices and general supportive care. Post-transplant relapse remains the leading cause of transplant failure in this group.https://www.frontiersin.org/articles/10.3389/frhem.2023.1274649/fullacute myeloid leukemiaallogenic transplantationoverall survivalprogression-free survivalgraft-versus-host disease |
| spellingShingle | Audrey M. Sigmund Justin Jiang Qiuhong Zhao Patrick Elder Don M. Benson Sumithira Vasu Samantha Jaglowski Alice S. Mims Hannah Choe Karilyn Larkin Jonathan E. Brammer Sarah A. Wall Nicole Grieselhuber William Basem Sam Penza Yvonne A. Efebera Nidhi Sharma Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience Frontiers in Hematology acute myeloid leukemia allogenic transplantation overall survival progression-free survival graft-versus-host disease |
| title | Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience |
| title_full | Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience |
| title_fullStr | Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience |
| title_full_unstemmed | Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience |
| title_short | Improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant: a long-term institutional experience |
| title_sort | improvement in survival of acute myeloid leukemia and myelodysplastic syndrome patients following allogeneic transplant a long term institutional experience |
| topic | acute myeloid leukemia allogenic transplantation overall survival progression-free survival graft-versus-host disease |
| url | https://www.frontiersin.org/articles/10.3389/frhem.2023.1274649/full |
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