Survival of patients with acute myeloid leukemia relapsing after allogeneic hematopoietic cell transplantation: a center for international blood and marrow transplant research study.
Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic cell transplantation (alloHCT) remains a major therapeutic challenge. We studied outcomes of 1788 AML patients relapsing after alloHCT (1990 to 2010) during first or second complete remission (CR) to identify factors associated with longer postrelapse survival. Median time to post-HCT relapse was 7 months (range, 1 to 177). At relapse, 1231 patients (69%) received intensive therapy, including chemotherapy alone (n = 660), donor lymphocyte infusion (DLI) ± chemotherapy (n = 202), or second alloHCT ± chemotherapy ± DLI (n = 369), with subsequent CR rates of 29%. Median follow-up after relapse was 39 months (range, <1 to 193). Survival for all patients was 23% at 1 year after relapse; however, 3-year overall survival correlated with time from HCT to relapse (4% for relapse during the 1- to 6-month period, 12% during the 6-month to 2-year period, 26% during the 2- to 3-year period, and 38% for ≥3 years). In multivariable analysis, lower mortality was significantly associated with longer time from alloHCT to relapse (relative risk, .55 for 6 months to 2 years; relative risk, .39 for 2 to 3 years; and relative risk, .28 for ≥3 years; P < .0001) and a first HCT using reduced-intensity conditioning (relative risk, .77; 95% confidence interval [CI], .66 to .88; P = .0002). In contrast, inferior survival was associated with age >40 years (relative risk, 1.42; 95% CI, 1.24 to 1.64; P < .0001), active graft-versus-host disease at relapse (relative risk, 1.25; 95% CI, 1.13 to 1.39; P < .0001), adverse cytogenetics (relative risk, 1.37; 95% CI, 1.09 to 1.71; P = .0062), mismatched unrelated donor (relative risk, 1.61; 95% CI, 1.22 to 2.13; P = .0008), and use of cord blood for first HCT (relative risk, 1.23; 95% CI, 1.06 to 1.42; P = .0078). AML relapse after alloHCT predicted poor survival; however, patients who relapsed ≥6 months after their initial alloHCT had better survival and may benefit from intensive therapy, such as second alloHCT ± DLI.
['Bejanyan|Nelli|N|', 'Weisdorf|Daniel J|DJ|', 'Logan|Brent R|BR|', 'Wang|Hai-Lin|HL|', 'Devine|Steven M|SM|', 'de Lima|Marcos|M|', 'Bunjes|Donald W|DW|', 'Zhang|Mei-Jie|MJ|']
D000293:Adolescent D000328:Adult D000367:Age Factors D000368:Aged D064591:Allografts D002648:Child D002675:Child, Preschool D018572:Disease-Free Survival D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D007223:Infant D007231:Infant, Newborn D015470:Leukemia, Myeloid, Acute D008297:Male D008875:Middle Aged D012008:Recurrence D012042:Registries D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate
Acute myeloid leukemia Relapse Donor lymphocyte infusion Allogeneic transplantation Second transplantation