A novel prognostic scoring system HATS for acute myeloid leukemia patients undergoing allogeneic hematopoietic stem cell transplantation.

The optimal prognostication model for outcome following allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia (AML) remains undefined. To establish a prognostic scoring system, 466 consecutive AML patients undergoing allo-HSCT from 2014 to 2023 were analyzed as a training cohort. Six donor, leukemia and recipient related factors were identified as prognostically significant and assigned weighted scores, respectively 1 point each for donor cytomegalovirus seropositivity, Hemopoietic Cell Transplantation-specific Comorbidity Index ≥ 2, secondary AML, not in first complete remission, and low-intensity induction therapy; 3 points for inv(3)/t(3;3)(q21;q26) or KMT2A rearrangement; 4 points for − 5/del(5q) or TP53 mutation; 0 point for CEBPA bZIP in-frame mutation or core-binding factor AML; and 1 point for all other genetic risk groups. Scores were grouped into four risk categories: favorable (0–1), intermediate (2–3), poor (4–5), and very poor (≥ 6); constituting the HATS prognostication model. The corresponding 2-year overall survivals of favorable, intermediate, poor and very poor risk groups were 92%, 78%, 50%, and 7.4% (log-rank P < 0.001). An external validation cohort comprising 395 patients was similarly analyzed. With concordance statistics, HATS outperformed all six existing prognostication models. In conclusion, HATS represents a novel prognostication model devised for AML patients undergoing allo-HSCT.Clinicaltrials.gov identifier: NCT06702111.