Comparison of myeloablative (CyTBI, BuCy) versus reduced-intensity (FluBu2TBI400) peripheral blood stem cell transplantation in acute myeloid leukemia patients with pre-transplant low WT1 expression

Silvia Park, Gi June Min, Sung Soo Park, Seung-Ah Yahng, Young-Woo Jeon, Seung-Hwan Shin, Jae-Ho Yoon, Sung-Eun Lee, Byung Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min, Seok-Goo Cho, Dong-Wook Kim, Jong Wook Lee, Hee-Je Kim
Biology of Blood and Marrow Transplantation 2020 July 10
Relapse is a major concern with reduced-intensity conditioning. We analyzed 257 acute myeloid leukemia (AML) patients who received allogeneic stem cell transplantation (SCT) and fulfilled the following criteria: intermediate or poor-risk disease by NCCN guidelines (2017.Version 3), in first complete remission (CR1) at SCT, received either myeloablative conditioning (MAC; BuCy or CyTBI) or reduced-intensity conditioning (RIC; FluBu2TBI400) peripheral blood SCT from 8/8 matched sibling or unrelated donor, and having bone marrow Wilms' tumour gene 1 (WT1) expression results before transplant. We and other groups serially published a predictive value for pre-transplant WT1 expression in AML patients to identify patients at higher risk of relapse. Among the total 257 patients, 191 (74.3%) and 66 (25.7%) patients received MAC and RIC transplants, respectively. WT1 ≥ 250 copies/104 ABL was defined as WT1high . WT1high before SCT was found to be an independent prognostic factor for inferior overall survival (OS), disease-free survival (DFS), and higher cumulative incidence of relapse (CIR). There were 201 patients with WT1 low expression based upon pre-transplant analysis. There was no significant difference in OS, DFS, CIR, and nonrelapse mortality between MAC and RIC patients. To conclude, post-transplant survival or relapse was not different by conditioning intensity in AML CR1 patients whose WT1 level was below 250 copies per 104 ABL at transplantation.

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