Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia.

Yanada, Masamitsu; Konuma, Takaaki; Mizuno, Shohei; Saburi, Masuho; Shinohara, Akihito; Tanaka, Masatsugu; Marumo, Atsushi; Sawa, Masashi; Uchida, Naoyuki; Ozawa, Yukiyasu; Onizuka, Makoto; Yoshioka, Satoshi; Nakamae, Hirohisa; Kondo, Tadakazu; Kimura, Takafumi; Kanda, Junya; Fukuda, Takahiro; Atsuta, Yoshiko; Nakasone, Hideki; Yano, Shingo

The aim of this study was to develop a comprehensive system for predicting non-relapse mortality after allogeneic hematopoietic cell transplantation (HCT) during first complete remission (CR) of acute myeloid leukemia (AML). After dividing 2344 eligible patients randomly into a training set and a validation set, we first identified and scored five parameters, that is, age, sex, performance status, HCT-comorbidity index (HCT-CI), and donor type, on the basis of their impact on non-relapse mortality for patients in the training set. The non-relapse mortality-J (NRM-J) index using the sum of these scores was then applied to patients in the validation set, resulting in a clear differentiation of non-relapse mortality, with expected 2-year rates of 11%, 16%, 27%, and 33%, respectively (P < 0.001). The estimated c-statistic was 0.67, which was significantly higher than that of the European Society for Blood and Marrow Transplantation score (0.60, P = 0.002) and the HCT-CI (0.57, P < 0.001). The NRM-J index showed a significant association with overall survival, but not with relapse. Our findings demonstrate that the NRM-J index is useful for predicting post-transplant non-relapse mortality for patients with AML in first CR, for whom the decision of whether to perform allogeneic HCT is critical.