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<p>Allogeneic stem cell transplant (ASCT) remains the only curative option in chronic myelomonocytic leukemia (CMML). We retrospectively analyzed 138 CMML patients who underwent ASCT at the Mayo Clinic. Patients who transitioned to ASCT while in chronic phase (Group A) displayed superior post-transplant survival (PTS), compared to those in whom ASCT was performed after blast transformation (BT; Group B) (median 95 vs. 16 months; <i>p</i> = 0.01). In Group A, PTS was superior in patients with &lt;5% bone marrow (BM) blasts at time of ASCT (median 164 vs. 13.5 months; <i>p</i> = 0.01). Other predictors of superior PTS included day-100 BM blast &lt;5% or normal cytogenetics (median 164 vs. 18 months; <i>p</i> = 0.01) or presence of chronic graft-versus-host-disease (GVHD; median 164 vs. 26 months; <i>p</i> = 0.01). Pre-ASCT hypomethylating agent exposure (HR = 2.03; <i>p</i> = 0.03), and receiving more than one line of pre-ASCT chemotherapy (<i>p</i> = 0.01) predicted inferior PTS. In multivariable analysis, predictors of superior GVHD-free and relapse-free survival (GRFS) included the use of myeloablative conditioning and the absence of morphologically or cytogenetically apparent disease at day-100. The use of post-transplant cyclophosphamide (PTCy) was associated with a higher cumulative incidence of relapse (<i>p</i> = 0.02) and numerically inferior PTS (<i>p</i> = 0.1). Group B patients also appeared to benefit from achieving BM blast &lt;5% at the time of ASCT (<i>p</i> = 0.4) as well as at day-100 (<i>p</i> = 0.01), in terms of PTS, while full chimerism and normal cytogenetics at day-100 were associated with superior GRFS. These observations support the value of ASCT in CMML, especially if performed prior to BT and in the presence of &lt;5% BM blasts at the time of ASCT. Additionally, the observed detrimental impact of PTCy requires additional studies to confirm and investigate the underlying mechanisms.</p>

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Allogeneic stem cell transplantation in chronic myelomonocytic leukemia: analysis of post-transplant survival and risk factors in 138 Mayo Clinic patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月6日

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  • Ali Alsugair,
  • Estefania Gauto Mariotti,
  • Mohammad M. Alhousani,
  • Saubia Fathima,
  • Muhammad Yousuf,
  • Abiola Bolarinwa,
  • James Foran,
  • Abishek A. Mangaonkar,
  • Mark Litzow,
  • Hemant Murthy,
  • Lisa Sproat,
  • Jeanne Palmer,
  • Aasiya Matin,
  • Ernesto Ayala,
  • James Slack,
  • Luis Porrata,
  • Madiha Iqbal,
  • Nandita Khera,
  • Nathan Punwani,
  • Saad Kenderian,
  • Saurabh Chhabra,
  • William J. Hogan,
  • Mithun Vinod Shah,
  • Hassan B. Alkhateeb,
  • Naseema Gangat,
  • Mrinal Patnaik,
  • Ayalew Tefferi

摘要

Allogeneic stem cell transplant (ASCT) remains the only curative option in chronic myelomonocytic leukemia (CMML). We retrospectively analyzed 138 CMML patients who underwent ASCT at the Mayo Clinic. Patients who transitioned to ASCT while in chronic phase (Group A) displayed superior post-transplant survival (PTS), compared to those in whom ASCT was performed after blast transformation (BT; Group B) (median 95 vs. 16 months; p = 0.01). In Group A, PTS was superior in patients with <5% bone marrow (BM) blasts at time of ASCT (median 164 vs. 13.5 months; p = 0.01). Other predictors of superior PTS included day-100 BM blast <5% or normal cytogenetics (median 164 vs. 18 months; p = 0.01) or presence of chronic graft-versus-host-disease (GVHD; median 164 vs. 26 months; p = 0.01). Pre-ASCT hypomethylating agent exposure (HR = 2.03; p = 0.03), and receiving more than one line of pre-ASCT chemotherapy (p = 0.01) predicted inferior PTS. In multivariable analysis, predictors of superior GVHD-free and relapse-free survival (GRFS) included the use of myeloablative conditioning and the absence of morphologically or cytogenetically apparent disease at day-100. The use of post-transplant cyclophosphamide (PTCy) was associated with a higher cumulative incidence of relapse (p = 0.02) and numerically inferior PTS (p = 0.1). Group B patients also appeared to benefit from achieving BM blast <5% at the time of ASCT (p = 0.4) as well as at day-100 (p = 0.01), in terms of PTS, while full chimerism and normal cytogenetics at day-100 were associated with superior GRFS. These observations support the value of ASCT in CMML, especially if performed prior to BT and in the presence of <5% BM blasts at the time of ASCT. Additionally, the observed detrimental impact of PTCy requires additional studies to confirm and investigate the underlying mechanisms.