Short Term Outcomes of the Patients Undergoing Allogenic Hematopoietic Stem Cell transplant for Acute Myeloid Leukemia; A Single Center Experience from developing World

Abstract

Background: Acute myeloid leukemia (AML) accounts for approximately 1% of all cancers. Despite the advancements in chemotherapy and targeted treatments, hematopoietic stem cell transplantation (HSCT) remains the only potentially curative option for patients with for relapsed refractory AML. This study aims to evaluate the short-term outcomes of patients undergoing HSCT for AML.

Methodology: This cross-sectional study was conducted at the AFBMTC from January 2022 to December 2023. Participants were selected through a convenient, non-probability sampling method. Ethical approval was obtained from the institutional review board of AFBMTC. Written informed consent was obtained from all patients or their legal guardians for both the transplant procedure and the use of their data for research purposes. Data was extracted from hospital record. Data was analyzed using SPSS version 23. Qualitative variables were presented as frequencies and percentages. Quantitative variables were summarized as medians with interquartile ranges (IQR) or means with standard deviations (SD). Kaplan-Meier survival analysis was used to estimate OS and DFS.

Results: A total of 41 patients underwent HSCT during the defined study duration and all were included in the study. There were 26 (63.4%) males and 15 (36.6%) females. The mean age of the patients was 24.46 ± 11.6 years. Thirty-eight patients (92.7%) were diagnosed with de novo AML, 2 (4.9%) progressed from MDS, and 1 (2.4%) had therapy-related AML. Risk stratification was available for 36 patients in which 9 (22%) had favorable risk category, 25 (61%), in relapsed refractory disease, intermediate and 2 (4.9%) were high risk category. Among all patient who underwent HSCT, 34 (82.9%) patients had a matched sibling donor (MSD) and 7 (17.1%) had haplo matched donor available. CMV reactivation was demonstrated in 16 (39%) patients while among 23 (56.1%) patient no CMV reactivation was recorded by the last day of follow-up. All of the patients received Myelo-ablative conditioning chemotherapy. the OS was 63.4% with mean survival of 281.71 + 112 days DFS was 46.3 % with mean survival of 269 + 123 days. By using log rank test, Mucositis had significant association with OS (P=0.001) and DFS (P=0.003).

Conclusion: Our study highlights that allogeneic HSCT with myeloablative conditioning achieves substantial short-term yields favorable engraftment and survival outcomes in patients with AML patients, with a 1-year overall survival rate of 63.4% and disease-free survival of 46.3%. Mucositis was prevalent in 80.5% of patients, was associated with significantly lower survival rates, highlighting the critical impact of early complications on overall outcomes. Additionally, the high incidence of acute and chronic GVHD (36.6% and 22%, respectively) and CMV reactivation (39%) highlights the need for refined prophylactic measures to reduce these complications. Future studies with larger, diverse populations and comprehensive molecular profiling are needed to refine these findings and guide tailored post-transplant strategies.

Keywords: Acute Myeloid Leukemia, Allogenic HSCT, Short-Term outcomes.