Allogeneic hematopoietic cell transplantation for acute myeloid leukemia in Japan: changes in practice patterns and outcomes during the past 20 years.

This study examined changes in practice patterns and outcomes of allogeneic hematopoietic cell transplantation (HCT) over the past 20 years. Data were analyzed from a Japanese nationwide registry of consecutive adult patients with acute myeloid leukemia who underwent allogeneic HCT between 2001 and 2020. The study population included 17,553 patients, of whom 6653 underwent allogeneic HCT in 2001-2010 and 10,900 in 2011-2020. Patients in the later period were older, were more likely to be in first complete remission, and more frequently received umbilical cord blood transplantation. After adjusting for major covariates, the 2011-2020 cohort had lower risks of overall mortality (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.80-0.89; P < 0.001), relapse (HR, 0.88; 95% CI, 0.83-0.95; P < 0.001), and non-relapse mortality (NRM; HR, 0.88; 95% CI, 0.81-0.95; P < 0.001). Subgroup analyses revealed improvements in overall survival (OS) regardless of age and disease status. The study found significant changes in allogeneic HCT practice in Japan and showed that the dual decrease in the risks of relapse and NRM contributed to the OS improvement, highlighting the substantial progress in this field over the past two decades.