EBMT 2025 | Outcomes of patients with AML in adverse cytogenetic subgroups undergoing alloSCT in first remission

So, as you know, the presence of cytogenetic abnormalities continues to be an important factor in determining clinical outcomes for patients newly diagnosed with AML. And currently, according to the European Leukemia Net 2022 classification, patients in the intermediate or adverse risk categories are typically offered allogeneic transplant in first remission. However, in the context of allo transplant, the frequency and prognostic value of different adverse risk karyotypes have not been extensively studied and may differ from those of patients treated with chemotherapy alone. 

So therefore, we evaluated through the EBMT registry adult patients with AML who received a first allo transplant in first complete remission between 2010 and 2022 with available full karyotype and diagnosis classified as ELN 2022 adverse risk. 

So we could identify 1,735 patients fulfilling these inclusion criteria, two-thirds had de novo AML. And then we could define 11 adverse risk cytogenetic abnormalities, non-overlapping groups. So the most frequent groups were patients with abnormalities of chromosome 17, patients with complex karyotype together with deletion of chromosome 5, monosomy 5, or monosomy 7, patients with isolated complex karyotype without structural abnormalities, and patients with deletion 5q, monosomy 5 and 7, but without complex karyotype. 

And basically, the outcomes were totally different. Although we are talking about the group of adverse risk karyotype, well, post-transplant outcomes were very bad or dismal for patients with abnormalities of chromosome 17 with a two-year leukemia-free survival of 22%, and patients with combined complex karyotype and monosomy 5 or 7 with two-year leukemia-free survival of 27%. So these are very bad. 

Conversely, if you have complex karyotype alone, then the two-year leukemia-free survival is 50%. If you have monosomy 5 or 7 or deletion 5q without complex karyotype, two-year leukemia-free survival is 55%. And this was confirmed in multivariate analysis. 

So overall, using this very large data set from EBMT, we can say that the presence of either monosomy 17 or 17p abnormalities, or the combination of complex karyotype with monosomy 5 or 7 or deletion 5q is essential to define the subset of patients with the worst prognosis. Conversely, within the ELN 2022 adverse risk population, patients with complex karyotype alone or monosomal 5 or 7 or deletion 5q alone exhibited relatively favorable post-transplant outcomes.

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