A holistic prognostic model for leukemia-free survival after allogeneic transplantation in acute leukemia.

Authors

Alexandros Spyridonidis, Allain Thibeault Ferhat, Jacques Emmanuel Galimard, Thomas Schroeder, Régis Peffault de Latour, Nicolaus Kröger, Didier Blaise, Matthias Stelljes, Matthias Eder, Tobias Gedde-Dahl, Igor Wolfgang Blau, Ibrahim Yakoub-Agha, Edouard Forcade, Anne Huynh, Francesca Kinsella, Hélène Labussière-Wallet, Jakob Passweg, Robert Zeiser, Mohamed Houhou, Bipin Savani, Roni Shouval, Jurjen Versluis, Mohamad Mohty, Fabio Ciceri, Annalisa Ruggeri

Published in

Bone marrow transplantation. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) can cure acute leukemia, but relapse and non-relapse mortality restrict its success. Existing models focus on single prognostic areas and are not designed to predict leukemia-free survival (LFS), the outcome that best reflects allo-HCT's curative intent. In this large retrospective cohort of allografted AL patients (N = 24,317), we combined key pre-transplant patient, disease, and treatment factors into a practical holistic H-score to predict post-allo-HCT LFS. Component weights were derived from Cox-regression hazard ratios in a training cohort (N = 19,029). The model was validated in a geographically split testing cohort (N = 4760), with outcomes assessed using Kaplan-Meier analysis and multivariate Cox models. In the overall cohort (N = 24,317), 2-year overall survival and LFS were 64% and 56%, respectively. The H-score stratified patients into four risk groups, with 2-year LFS ranging from 66.2% in the low-risk group to 32.0% in the very high-risk group. The H-score was the strongest independent predictor of LFS (p < 0.0001), outperforming individual indices and offering more refined risk stratification. The H-score was also an independent predictor of overall survival, relapse, and non-relapse mortality. While individual prediction is limited, the H-score aids patient counseling and provides a useful baseline for comparing new transplant treatments.

PMID:
42393231
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.

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