Pre-transplant testosterone and outcome of men after allogeneic stem cell transplantation

Area of Science:

• Hematology
• Endocrinology
• Oncology

Background:

• Testosterone significantly influences endothelial function and vascular health in men.
• Endothelial function and vascular health are critical factors affecting mortality post-allogeneic stem cell transplantation (alloSCT).
• The role of pre-transplant testosterone levels in alloSCT outcomes, particularly in acute myeloid leukemia (AML), requires investigation.

Purpose of the Study:

• To retrospectively evaluate the impact of pre-transplant testosterone levels on outcomes in male patients undergoing alloSCT.
• To determine if testosterone levels predict overall survival (OS), non-relapse mortality (NRM), or relapse in AML patients post-alloSCT.

Main Methods:

• Retrospective analysis of two cohorts of male patients undergoing alloSCT for AML.
• Discovery cohort (n=346) for initial observation, training cohort (n=176) for hypothesis refinement.
• Confirmation cohort (n=168) to validate findings, utilizing multivariable models and cause-specific hazard ratios.

Main Results:

• Lower pre-transplant testosterone levels were associated with shorter OS and higher NRM in the training cohort (AML patients).
• These associations were replicated in the confirmation cohort, with low testosterone (<250 ng/dL) linked to significantly worse OS and increased NRM.
• Pre-transplant testosterone levels did not significantly impact relapse rates in either cohort.

Conclusions:

• Pre-transplant testosterone levels are a significant predictor of survival and NRM in male patients undergoing alloSCT for AML.
• Low testosterone status (<250 ng/dL) is associated with poorer outcomes, independent of relapse risk.
• Findings support further research into testosterone/androgen assessment and potential supplementation strategies for AML patients undergoing alloSCT.