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An 8-year pragmatic observation evaluation of the benefits of allogeneic HCT in older and medically infirm patients with AML

Sorror, Mohamed L. ; Gooley, Ted A. ; Storer, Barry E. ; Gerds, Aaron T. ; Sekeres, Mikkael A. ; Medeiros, Bruno C. ; Wang, Eunice S. ; Shami, Paul J. ; Adekola, Kehinde ; Luger, Selina ; Baer, Maria R. ; Rizzieri, David A. ; Wildes, Tanya M. ; Koprivnikar, Jamie ; Smith, Julie ; Garrison, Mitchell ; Kojouri, Kiarash ; Schuler, Tammy A. ; Leisenring, Wendy M. ; Onstad, Lynn E. ; Becker, Pamela S. ; McCune, Jeannine S. ; Lee, Stephanie J. ; Sandmaier, Brenda M. ; Appelbaum, Frederick R. ; Estey, Elihu H.

Blood, 2023-01, Vol.141 (3), p.295-308 [Periódico revisado por pares]

United States: Elsevier Inc

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  • Título:
    An 8-year pragmatic observation evaluation of the benefits of allogeneic HCT in older and medically infirm patients with AML
  • Autor: Sorror, Mohamed L. ; Gooley, Ted A. ; Storer, Barry E. ; Gerds, Aaron T. ; Sekeres, Mikkael A. ; Medeiros, Bruno C. ; Wang, Eunice S. ; Shami, Paul J. ; Adekola, Kehinde ; Luger, Selina ; Baer, Maria R. ; Rizzieri, David A. ; Wildes, Tanya M. ; Koprivnikar, Jamie ; Smith, Julie ; Garrison, Mitchell ; Kojouri, Kiarash ; Schuler, Tammy A. ; Leisenring, Wendy M. ; Onstad, Lynn E. ; Becker, Pamela S. ; McCune, Jeannine S. ; Lee, Stephanie J. ; Sandmaier, Brenda M. ; Appelbaum, Frederick R. ; Estey, Elihu H.
  • Assuntos: Aged ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid, Acute - therapy ; Prospective Studies ; Quality of Life ; Remission Induction ; Retrospective Studies
  • É parte de: Blood, 2023-01, Vol.141 (3), p.295-308
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
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  • Descrição: •Models adjusted for AML and patient-specific variables showed no benefit of allogeneic HCT in patients that are older or medically infirm.•Current practice of offering HCT to older and medically infirm patients with AML is not evidence based, which calls for randomized trials. [Display omitted] We designed a prospective, observational study enrolling patients presenting for treatment of acute myeloid leukemia (AML) at 13 institutions to analyze associations between hematopoietic cell transplantation (HCT) and survival, quality of life (QOL), and function in: the entire cohort, those aged ≥65 years, those with high comorbidity burden, intermediate cytogenetic risk, adverse cytogenetic risk, and first complete remission with or without measurable residual disease. Patient were assessed 8 times over 2 years. Time-dependent regression models were used. Among 692 patients that were evaluable, 46% received HCT with a 2-year survival of 58%. In unadjusted models, HCT was associated with reduced risks of mortality most of the subgroups. However, after accounting for covariates associated with increased mortality (age, comorbidity burden, disease risks, frailty, impaired QOL, depression, and impaired function), the associations between HCT and longer survival disappeared in most subgroups. Although function, social life, performance status, and depressive symptoms were better for those selected for HCT, these health advantages were lost after receiving HCT. Recipients and nonrecipients of HCT similarly ranked and expected cure as main goal of therapy, whereas physicians had greater expectations for cure than the former. Accounting for health impairments negates survival benefits from HCT for AML, suggesting that the unadjusted observed benefit is mostly owing to selection of the healthier candidates. Considering patients’ overall expectations of cure but also the QOL burdens of HCT motivate the need for randomized trials to identify the best candidates for HCT. This trial was registered at www.clinicaltrials.gov as #NCT01929408. Allogeneic hematopoietic cell transplantation (HCT) is recommended by guidelines for fit patients with high-risk acute myeloid leukemia (AML). Sorror and colleagues report multi-institutional observational data with mature follow up, analyzed after adjusting for AML- and patient-specific variables, showing no benefit of HCT in older and medically infirm patients, with the exception of 2 subgroups. These data challenge the applicability of current broad guidelines for older patients and indicate the need for randomized trials on this issue in these patients, especially in the era of new induction therapies.
  • Editor: United States: Elsevier Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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