Clinical features and prognostic nomogram for therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation

Therapy-related acute myeloid leukemia (t-AML), which develops after cytotoxic therapy, has a poorer prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential cure, its efficacy varies among patients. In this retrospective study, we analyzed 154 patients with t-AML who underwent hematopoietic stem cell transplantation (HSCT) at our institution to determine their clinical characteristics and develop a prognostic nomogram. The median ages at t-AML diagnosis prior disease diagnosis was 42 and 39 years, respectively. Multivariate analysis identified key prognostic indicators: leukocyte count at AML diagnosis >= 7 x 10<^>9/L, genetic abnormalities before HSCT, platelet engraftment >= 28 days, age at prior disease >= 45 years, and relapse of prior disease. We developed a prognostic nomogram for LGPAR by categorizing patients into low, medium, and high-risk groups. The 3-year and 5-year overall survival (OS) rates for these groups were 92.6 %, 84.4 %, 14 %, and 92.6 %, 76.6 %, and 7 %, respectively. The 3-year and 5-year relapse-free survival (RFS) rates were 80 %, 75.9 %, 10.7 % and 80 %, 72.6 %, and 10.7 % for the respective risk groups. The 3-year and 5-year non-relapse mortality (NRM) rates were 0 %, 5.6 %, 63.3 % and 0 %, 9.3 %, and 63.3 % for these groups, respectively. This novel prognostic nomogram culminates in the development of a clinical decision-support tool for patients with t-AML undergoing allo-HSCT.