Measurable residual disease (MRD) prior to hematopoietic cell transplant (HCT) for acute myeloid leukemia (AML) in first complete morphological remission (CR1) is an independent predictor of outcome, but few studies address CR2. This analysis by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation registry assessed HCT outcomes by declared MRD status in a cohort of 1042 adult patients with AML CR2 at HCT. Patients were transplanted 2006-2016 from human leukocyte antigen (HLA) matched siblings (n = 719) or HLA 10/10 matched unrelated donors (n = 293). Conditioning was myeloablative (n = 610) or reduced-intensity (n = 432) and 566 patients (54%) had in-vivo T cell depletion. At HCT, 749 patients (72%) were MRD negative (MRD NEG) and 293 (28%) were MRD positive (MRD POS). Time from diagnosis to HCT was longer in MRD NEG than MRD POS patients (18 vs. 16 months (P < 0.001). Two-year relapse rates were 24% (95% CI, 21-28) and 40% (95% CI, 34-46) in MRD NEG and MRD POS groups (P < 0.001), respectively. Leukemia-free survival (LFS) was 57% (53-61) and 46% (40-52%), respectively (P = 0.001), but there was no difference in terms of overall survival. Prognostic factors for relapse and LFS were MRD NEG status, good risk cytogenetics, and longer time from diagnosis to HCT. In-vivo T cell depletion predicted relapse.

Acute Leukemia Working Party European Society for Blood and Marrow Transplantation Paris Study Office European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy Paris France

CHU de Lille LIRIC INSER U995 Université de Lille Lille France

Department of Bone Marrow Transplantation West German Cancer Center University Hospital of Essen Essen Germany

Department of Haematology Rigshospitalet Copenhagen Denmark

Department of Hematology Hemostasis Oncology and Stem Cell Transplantation Hannover Medical School Hannover Germany

EBMT Paris study office CEREST TC Paris France

Hematologie Transplantation Hôpital St Louis Paris CEDEX 10 France

Hematology and Bone Marrow Transplantation Division Chaim Sheba Medical Center Tel Hashomer Sackler School of Medicine Tel Aviv University 6997801 Tel Aviv Israel

Hematology Division Chaim Sheba Medical Center Tel Hashomer Israel

Hematology Service Institute of Hematology and Blood Transfusion Prague Czech Republic

Hôpital Saint Antoine INSERM UMR 938 Paris France; Université Pierre et Marie Curie Paris France

Kapadokya BMT Center Kayseri Turkey

Leeds Teaching Hospitals Trust St James's University Hospital Leeds LS9 7TF United Kingdom

Manchester Royal Infirmary Manchester United Kingdom

University Hospital Bristol NHS Foundation Trust London United Kingdom

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Allogeneic stem cell transplantation for patients with acute myeloid leukemia (AML) in second complete remission (CR2) transplanted from unrelated donors with post-transplant cyclophosphamide (PTCy). A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation