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

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.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2026-07-02
DOI
https://doi.org/10.1038/s41409-026-02950-w
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
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article

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

Nicolaus Martin Kröger, Jakob Robert Passweg, Matthias Stelljes, Alexandros Spyridonidis et al.
Bone Marrow Transplantation
Hematopoietic Stem Cell Transplantation
article

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

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

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.

Bone Marrow Transplantation
Oslo University Hospital (NO), Memorial Sloan Kettering Cancer Center (US), Universität Hamburg (DE), University of Freiburg (DE), University of Patras (GR), Cornell University (US), Erasmus MC (NL), University Hospital of Basel (CH), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Toulouse (FR), Medizinische Hochschule Hannover (DE), Sorbonne Université (FR), Hôpital Saint-Antoine (FR), University Hospital Münster (DE), University Medical Center Hamburg-Eppendorf (DE), Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DE), Hôpital Lyon Sud (FR), Essen University Hospital (DE), Hôpital Cardiologique du Haut-Lévêque (FR), IRCCS Ospedale San Raffaele (IT), Hôpital Saint-Louis (FR), Cellular Therapeutics (United Kingdom) (GB), Institut Paoli-Calmettes (FR), Vanderbilt University Medical Center (US), Erasmus University Rotterdam (NL)
Good health and well-being
Openalex Percentile: Top 8%
Hematopoietic Stem Cell Transplantation
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