Patient age, remission status and HCT-CI in a combined score are prognostic for patients with AML undergoing allogeneic hematopoietic cell transplantation in CR1 and CR2

For AML, older age, advanced disease and increased hematopoietic cell transplant comorbidity index (HCT-CI) are associated with worse prognosis following allogeneic hematopoietic cell transplantation (HCT). This single-center retrospective study investigated the influence of pre-transplant characteristics on outcomes of 387 patients undergoing allogeneic HCT for AML in CR1 and CR2. The multivariable analysis model for overall survival (OS) included age (hazard ratio (HR) = 2.24 for ages 31-64 years and HR = 3.23 for age >= 65 years compared with age <= 30 years, P = 0.003), remission status (HR = 1.49 for CR2 compared with CR1, P = 0.005) and HCT-CI score (HR = 1.47 for >= 3 compared with < 3, P = 0.005). Transplant year was significantly associated with OS (P = 0.001) but this did not influence the model. A weighted score was developed with age <= 30, CR1 and HCT-CI score < 3 receiving 0 points each, and CR2 and HCT-CI score >= 3 receiving 1 point each. Ages 31-64 received 2 points, age >= 65 received 3 points. Scores were grouped as follows: scores 0-1 (low risk, n = 36), score 2 (intermediate-low risk, n = 147), score 3 (intermediate-high risk, n = 141) and scores 4-5 (high risk, n = 63) with 3-year OS of 71%, 55%, 42% and 29% for scores 0-1, 2, 3 and 4-5, respectively (P < 0.0001). The score predicted nonrelapse mortality (P = 0.03) but not cumulative incidence of relapse (P = 0.18). This model should be validated for the pre-HCT assessment of AML patients in CR1 and CR2.