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2243 Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients with Acute Myeloid Leukemia Harboring KMT2A Rearrangement and Its Prognostic Factors

Program: Oral and Poster Abstracts
Session: 732. Allogeneic Transplantation: Disease Response and Comparative Treatment Studies: Poster I
Hematology Disease Topics & Pathways:
Acute Myeloid Malignancies, AML, Biological therapies, Clinical Research, Diseases, Therapies, Myeloid Malignancies, Minimal Residual Disease , Transplantation
Saturday, December 9, 2023, 5:30 PM-7:30 PM

Bingqian Jiang1*, Yanmin Zhao1*, Yi Luo1*, Jian Yu1*, Yi Chen2*, Baodong Ye, MD3*, Huarui Fu1*, Xiaoyu Lai1*, Lizhen Liu1*, Yishan Ye, MD1*, Weiyan Zheng, MD1*, Jie Sun1*, Jingsong He4*, Yi Zhao1*, Guoqing Wei1*, Zhen Cai1*, He Huang1* and Jimin Shi1*

1Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
2Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
3The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
4The Department of Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Background: KMT2A rearrangement (KMT2A-r) in patients with acute myeloid leukemia (AML) is associated with poor outcomes; the prognostic factors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear.

Methods: We investigated 364 adults with AML who underwent allo-HSCT between April 2016 and May 2022, and 45 had KMT2A-r among them. Propensity score analysis with 1:1 matching and the nearest neighbor matching method identified 42 patients in KMT2A-r and non-KMT2A-r cohorts respectively.

Results: The 2-year overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapsed mortality (NRM) rates of patients with KMT2A-r were 59.1%, 49.6%, 41.5%, and 8.9%, respectively. With propensity score matching, the 2-year OS rate of KMT2A-r patients was lower than in those without KMT2A-r (56.1% vs. 88.1%, P=0.003), and in patients who achieved first complete remission (CR1), flow cytometry-based measurable residual disease (FCM-MRD) <1% and KMT2A-r negative before HSCT, the difference in the 2-year OS rate was reduced (71.5% vs. 93.9%, P=0.065). Patients with KMT2A-r exhibited the prognostic advantage from transplantation while in CR1 with FCM-MRD <1% and KMT2A-r negative which was reflected in OS, RFS, and CIR (P<0.001, P<0.001, P=0.002, respectively). Besides, there were differences in OS, RFS, and CIR depending on KMT2A-r subtypes (P=0.032, P=0.001, P=0.001, respectively). However, there was no difference regardless of the presence of mutations (all P>0.05). Univariate and multivariate analyses demonstrated that achieving CR1, FCM-MRD <1% and KMT2A-r negative before HSCT was a protective factor for OS (HR=0.242, P=0.007), RFS (HR=0.350, P=0.036), and CIR (HR=0.271, P=0.021), while AF6 was a risk factor for RFS (HR=2.985, P=0.028) and CIR (HR=4.675, P=0.004).

Conclusion: The poor prognosis of patients with KMT2A-r AML is associated with KMT2A-r subtypes, but not the presence of mutations. These patients can benefit from achieving CR1, FCM-MRD <1% and KMT2A-r negative before HSCT.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH