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External validation and extended application of the transplant conditioning intensity score in acute myeloid leukemia

Bone Marrow Transplantation volume 58, pages 1096–1103 (2023)Cite this article

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Abstract

This study aimed to validate the utility of the transplant conditioning intensity (TCI) score in 1714 patients with acute myeloid leukemia (AML) undergoing allogeneic bone marrow or peripheral blood stem cell transplantation (BMT/PBSCT) and assess its applicability to 753 patients with AML undergoing umbilical cord blood transplantation (UCBT) both during first complete remission. Patients classified into a high TCI group accounted for 63% and 56% in the BMT/PBSCT and UCBT cohorts, respectively. In the BMT/PBSCT cohort, the risk of relapse was lower in patients in the high versus intermediate TCI group (P = 0.002), although non-relapse mortality (NRM) did not differ among the three TCI groups. In the UCBT cohort, both relapse and NRM did not differ among the TCI groups. Increasing cutoff points for intermediate and high TCI categories significantly improved the ability to predict relapse and NRM in the BMT/PBSCT cohort (P = 0.030 and 0.006, respectively), and relapse but not NRM in the UCBT cohort (P = 0.005 and 0.364, respectively). These findings highlight the difference in the threshold level of the TCI score for outcome discrimination between European and Japanese cohorts. The TCI scheme appears less effective for UCBT than for BMT/PBSCT.

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Fig. 1: Outcomes of patients undergoing allogeneic bone marrow or peripheral blood stem cell transplantation according to the TCI category.
Fig. 2: Outcomes of patients undergoing allogeneic bone marrow or peripheral blood stem cell transplantation according to the modified TCI category.
Fig. 3: Outcomes of patients undergoing umbilical cord blood transplantation according to the TCI category.
Fig. 4: Outcomes of patients undergoing umbilical cord blood transplantation according to the modified TCI category.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported in part by a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED) (grant no. 19ek0510023h0003) (YA).

Author information

Authors and Affiliations

  1. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

  2. Kobe City Medical Center General Hospital, Kobe, Japan

    Yoshimitsu Shimomura, Tadakazu Kondo & Nobuhiro Hiramoto

  3. Aichi Medical University, Nagakute, Japan

    Shohei Mizuno & Yoshiko Atsuta

  4. Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Kensuke Matsuda

  5. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  6. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  7. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  8. Hokkaido University Hospital, Sapporo, Japan

    Takahide Ara

  9. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  10. Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  11. Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  12. Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  13. Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  14. Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  15. Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  16. Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  17. Keio University School of Medicine, Tokyo, Japan

    Shinichiro Okamoto

  18. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  19. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

Authors
  1. Masamitsu Yanada
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  2. Yoshimitsu Shimomura
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  4. Kensuke Matsuda
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  6. Noriko Doki
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  7. Masatsugu Tanaka
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  9. Takahide Ara
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  19. Shinichiro Okamoto
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  20. Yoshiko Atsuta
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  21. Takaaki Konuma
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Contributions

MY designed the study, analyzed data, interpreted the results, and drafted the paper; YS, SM, KM, T Kondo, ND, MT, TF, TA, NU, MO, MS, YO, NH, S Ota, and T Konuma interpreted results and revised the paper; JK, YK, TI, S Okamoto, and YA contributed to data management, interpreted the results, and revised the paper; and all authors approved the final version of the paper.

Corresponding author

Correspondence to Masamitsu Yanada.

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Yanada, M., Shimomura, Y., Mizuno, S. et al. External validation and extended application of the transplant conditioning intensity score in acute myeloid leukemia. Bone Marrow Transplant 58, 1096–1103 (2023). https://doi.org/10.1038/s41409-023-02037-w

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