Early tapering of immunosuppressive agents after HLA-matched donor transplantation can improve the survival of patients with advanced acute myeloid leukemia

Jun Yang, Yu Cai, JieLing Jiang, LiPing Wan, HaiTao Bai, Jun Zhu, Su Li, Chun Wang, Xianmin Song, Jun Yang, Yu Cai, JieLing Jiang, LiPing Wan, HaiTao Bai, Jun Zhu, Su Li, Chun Wang, Xianmin Song

Abstract

Disease recurrence is the most important obstacle to achieve long-term survival for patients with advanced acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In order to reduce the relapse risk and improve the survival, the strategy of early tapering of immunosuppressive agents was prospectively evaluated. Thirty-one patients with advanced AML received early tapering of immunosuppressive drugs, while 32 patients with AML in complete remission (CR) were given the routine tapering of immunosuppressive agents after HLA-matched donor transplantation. All advanced AML patients achieved CR after allo-HSCT. At 24 months after transplantation, relapse incidences were 22% in advanced group and 16% in CR group (P = 0.553); disease-free survival (DFS) and overall survival (OS) were 57.7 and 57.8% in advanced group, while in CR group were 66.6% (P = 0.388) and 66.2% (P = 0.423); immunosuppressive agent-free DFS (IDFS) were similar between two groups (P = 0.407). Acute graft-versus-host disease (aGvHD) incidences were similar between two groups (P = 0.311). Chronic GvHD (cGvHD) incidence was much higher in advanced group than in CR group (70.4 vs 38.7%, P = 0.02), but severe cGvHD had no difference. In multivariate analysis, cGvHD was an independent prognostic factor for lower risk of relapse and better DFS and OS; early tapering of immunosuppressive agents was an independent prognostic factor for cGvHD. The study suggested that advanced AML patients could be directly treated with allo-HSCT and its survival could be improved through the strategy of early tapering of immunosuppressive agents without significant adverse effects ( Clinicaltrials.org NCT03150134).

Keywords: Acute myeloid leukemia (AML); Allogeneic; Hematopoietic stem cell transplantation (HSCT); Immunosuppressive agents.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The flow diagram of immunosuppressive agent modulation after HLA-matched donor transplantation. CDC, complete donor chimerism; MDC, mixed donor chimerism; GvHD, graft-versus-host disease
Fig. 2
Fig. 2
Clinical outcomes of patients in CR group and advanced group with allo-HSCT. a Cumulative incidence (CI) of relapse, b non-relapse mortality (NRM), c disease-free survival (DFS), d overall survival (OS), and e immunosuppressive agent-free DFS (IDFS)
Fig. 3
Fig. 3
Clinical outcomes of patients with and without chronic graft-versus-host disease (cGvHD). a Cumulative incidence (CI) of relapse; b disease-free survival (DFS), and c overall survival (OS)

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