Personalized Prognostic Risk Score for Long-Term Survival for Children with Acute Leukemia after Allogeneic Transplantation

- We developed a personalized risk score for long-term survival after hematopoietic cell transplantation for patients with acute myeloid leukemia and acute lymphoblastic leukemia
- For acute myeloid leukemia, the risk score is based on age at hematopoietic cell transplantation, disease status, cytogenetic risk, and chronic graft-versus-host disease
- For acute myeloid leukemia, risk is categorized as good risk (score ≤2), intermediate risk (score 3), or poor risk (score ≥4)
- For acute lymphoblastic leukemia risk, the risk score is based on age at hematopoietic cell transplantation and chronic graft-versus-host disease
- For acute lymphoblastic leukemia, risk is categorized as good risk (score ≤1) or poor risk (score 2)

We studied leukemia-free (LFS) and overall survival (OS) in children with acute myeloid (AML, n = 790) and acute lymphoblastic leukemia (ALL, n = 1096) who underwent transplantation between 2000 and 2010 and who survived for at least 1 year in remission after related or unrelated donor transplantation. Analysis of patient-, disease-, and transplantation characteristics and acute and chronic graft-versus-host disease (GVHD) was performed to identify factors with adverse effects on LFS and OS. These data were used to develop risk scores for survival. We did not identify any prognostic factors beyond 4 years after transplantation for AML and beyond 3 years for ALL. Risk score for survival for AML includes age, disease status at transplantation, cytogenetic risk group, and chronic GVHD. For ALL, the risk score includes age at transplantation and chronic GVHD. The 10-year probabilities of OS for AML with good (score 0, 1, or 2), intermediate (score 3), and poor risk (score 4, 5, 6, or 7) were 94%, 87%, and 68%, respectively. The 10-year probabilities of OS for ALL were 89% and 80% for good (score 0 or 1) and poor risk (score 2), respectively. Identifying children at risk for late mortality with early intervention may mitigate some excess late mortality.