CT-194: Prognostic Factors Affecting Day +100 Survival in Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation for Acute Leukemia—A Single-Center Experience

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Objective To determine the factors affecting the first 100 days of survival in acute leukemia patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). Design Retrospective cohort study conducted at the Bone Marrow Transplant Center, Rawalpindi, Pakistan, from March 2016 to February 2022. Patients with acute leukemia (acute myeloid leukemia [AML] or acute lymphoblastic leukemia [ALL]) in complete remission (CR) undergoing allo-HSCT were included. Data were collected on patient demographics, diagnosis, remission status, pre-transplant analysis, donor compatibility, conditioning regimen, graft-versushost disease (GVHD) prophylaxis, engraftment times, post-transplant complications, mortality causes, and overall survival (OS) at 100 days. Results Among 101 transplant recipients (mean age, 24 ± 11.05 years; males, n = 76; females, n = 25), 41 had AML and 60 had ALL. Ninety patients underwent matched sibling donor HSCT, whereas 11 had haploidentical sibling HSCT. Patients ≤13 years had higher survival rates compared to older patients (94.4% vs 67.5%; P = 0.03). High pre-transplant serum ferritin levels (>2,500 mg/dL) predicted lower OS (48.9% vs 100% in ferritin <1,000 mg/dL; P < 0.01). AML patients had a survival advantage over ALL patients (82.9% vs 65%; P = 0.05). Early neutrophil engraftment within 14 days correlated with better survival (96.4% vs 54.3%; P < 0.01). Lastly, severe mucositis also adversely affected survival (60% with grade 3 vs 9.5% with grade 4; P < 0.01). Conclusion Identifying modifiable factors can improve long-term support and follow-up for patients with acute leukemia receiving allo-HSCT, enhancing patient outcomes in underdeveloped nations.

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