Accéder directement au contenu Accéder directement à la navigation
Article dans une revue

A personalized approach to guide allogeneic stem cell transplantation in younger adults with acute myeloid leukemia

Laurene Fenwarth 1, 2 Xavier Thomas 3 Stephane De Botton 4, 5 Nicolas Duployez 1 Jean-Henri Bourhis 5 Auriane Lesieur 1 Gael Fortin 6 Paul-Arthur Meslin 6 Ibrahim Yakoub-Agha 7, 8 Pierre Sujobert 9 Pierre-Yves Dumas 10, 11 Christian Recher 12 Delphine Lebon 13, 14 Celine Berthon 2 Mauricette Michallet 15 Arnaud Pigneux 11 Stephanie Nguyen 16 Sylvain Chantepie 17 Norbert Vey 18 Emmanuel Raffoux 19 Karine Celli-Lebras 20 Claude Gardin 21 Juliette Lambert 22, 23 Jean-Valere Malfuson 24 Denis Caillot 25 Sebastien Maury 26 Benoit Ducourneau 1 Pascal Turlure 27 Emilie Lemasle 28 Cecile Pautas 29 Sylvie Chevret 30 Christine Terre 22 Nicolas Boissel 19 Gerard Socie 19 Herve Dombret 19 Claude Preudhomme 1 Raphael Itzykson 6 
Abstract : A multistage model instructed by a large dataset (knowledge bank [KB] algorithm) has recently been developed to improve outcome predictions and tailor therapeutic decisions, including hematopoietic stem cell transplantation (HSCT) in acute myeloid leukemia (AML). We assessed the performance of the KB in guiding HSCT decisions in first complete remission (CR1) in 656 AML patients younger than 60 years from the ALFA-0702 trial (NCT00932412). KB predictions of overall survival (OS) were superior to those of European LeukemiaNet (ELN) 2017 risk stratification (C-index, 68.9 vs 63.0). Among patients reaching CR1, HSCT in CR1, as a time-dependent covariate, was detrimental in those with favorable ELN 2017 risk and those with negative NPM1 minimal residual disease (MRD; interaction tests, P = .01 and P = .02, respectively). Using KB simulations of survival at 5 years in a scenario without HSCT in CR1 (KB score), we identified, in a similar time-dependent analysis, a significant interaction between KB score and HSCT, with HSCT in CR1 being detrimental only in patients with a good prognosis based on KB simulations (KB score >= 40; interaction test, P = .01). We could finally integrate ELN 2017, NPM1 MRD, and KB scores to sort 545 CR1 patients into 278 (51.0%) HSCT candidates and 267 (49.0%) chemotherapy-only candidates. In both time-dependent and 6-month landmark analyses, HSCT significantly improved OS in HSCT candidates, whereas it significantly shortened OS in chemotherapy-only candidates. Integrating KB predictions with ELN 2017 and MRD may thus represent a promising approach to optimize HSCT timing in younger AML patients.
Type de document :
Article dans une revue
Liste complète des métadonnées

https://hal-u-picardie.archives-ouvertes.fr/hal-03606390
Contributeur : Louise DESSAIVRE Connectez-vous pour contacter le contributeur
Soumis le : vendredi 11 mars 2022 - 17:44:08
Dernière modification le : mardi 27 septembre 2022 - 10:06:16

Lien texte intégral

Identifiants

Citation

Laurene Fenwarth, Xavier Thomas, Stephane De Botton, Nicolas Duployez, Jean-Henri Bourhis, et al.. A personalized approach to guide allogeneic stem cell transplantation in younger adults with acute myeloid leukemia. Blood, American Society of Hematology, 2021, 137 (4), pp.524-532. ⟨10.1182/blood.2020005524⟩. ⟨hal-03606390⟩

Partager

Métriques

Consultations de la notice

38