GAMMA: A genetic-clinical prognostic model for risk stratification in patients with relapsed/refractory acute myeloid leukemia receiving allogeneic hematopoietic stem cell transplantation.

Authors

Yue Jin, Zhuo-Yu An, Peng Zhao, Hai-Xia Fu, Ying Lu, Dingming Wan, Xi Zhang, Fang Zhou, Nainong Li, Li Liu, Pengcheng He, ShiFeng Lou, Fei Li, Lu Wang, Han Zhu, Ruize Chen, Junjie Cao, Li Li, Xiao Hu, Li Li, Qianqian Xiao, Xufei Huang, Xueqian Yan, Xiaoning Wang, Yunya Luo, Mingyang Deng, Qiu-Sha Huang, Li-Ping Yang, Chen-Cong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Xiang-Yu Zhao, Yu Wang, Ying-Jun Chang, Lan-Ping Xu, Xiao-Jun Huang, Xiao-Hui Zhang

Published in

Cancer letters. Pages 218883. Oct 08, 2026. Epub Oct 08, 2026.

Abstract

The prognosis of patients diagnosed with relapsed/refractory acute myeloid leukemia (R/R AML) remains poor, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative strategy. An integrated model incorporating both genetic and clinical features to inform clinical decision-making in the HSCT setting for R/R AML patients is still lacking. In the current study, 301 R/R AML patients who underwent allo-HSCT at Peking University People's Hospital from 2018 to 2023 were included in the derivation group. A total of 297 R/R AML patients from 11 other HSCT centers in China were included in the external validation group. A total of 54 R/R AML patients who underwent allo-HSCT at Peking University People's Hospital in 2025 were assembled as a prospective validation cohort. A comprehensive prognostic model combining clinical factors and genetic abnormalities, including disease status before HSCT, patient and donor age, FLT3-ITD, TP53 mutation, KMT2A rearrangement (KMT2Ar) and complex karyotypes, for R/R AML patients treated with allo-HSCT was developed. Patients were stratified into four risk groups: low-risk, intermediate-low-risk, intermediate-high-risk, and high-risk. In the internal validation cohort, the 1-, 2- and 3-year time-dependent area under the curve (AUC) values of overall survival (OS) were 0.768, 0.795 and 0.799, respectively. In the external validation cohort, the 1-, 2- and 3-year time-dependent AUC values of OS were 0.676, 0.729 and 0.786, respectively. The 1-year AUC of the prospective validation cohort reached 0.79. This model could refine risk stratification in R/R AML patients undergoing allo-HSCT, and potentially inform combination therapy strategies and post-transplantation monitoring.

PMID:
42849654
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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