Prognostic factors and clinical outcomes in patients with relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 58; no. 8; pp. 863 - 873
• Main Authors: Gao, Yang, Wu, Hengwei, Shi, Zhuoyue, Gao, Fei, Shi, Jimin, Luo, Yi, Yu, Jian, Lai, Xiaoyu, Fu, Huarui, Liu, Lizhen, Huang, He, Zhao, Yanmin
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2023; Nature Publishing Group
• Subjects: 692/499; 692/699/1541/1990/283; Acute Disease; Acute lymphoblastic leukemia; Acute myeloid leukemia; Allografts; Bone marrow; Bone marrow transplantation; Cell Biology; Graft versus host disease; Graft vs Host Disease; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute - complications; Lymphatic leukemia; Medical prognosis; Medicine; Medicine & Public Health; Prognosis; Public Health; Recurrence; Remission; Retrospective Studies; Risk factors; Stem cell transplantation; Stem Cells; Survival; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-023-01989-3

Relapse is a significant barrier to allogeneic hematopoietic stem cell transplantation (allo-HSCT) success. To explore the prognosis of patients who underwent relapse after allo-HSCT, we retrospectively examined 740 consecutive acute leukemia patients in our single center transplanted between January 2013 and December 2018, of which 178 relapsed. The median survival was 204 days (95%CI, 160.7–247.3) from relapse, and the 3-year post-relapse overall survival (prOS) rate was 17.8% (95%CI, 12.5–25.3%). Overall complete remission (CR) or CR with incomplete hematologic recovery (CRi) was achieved in 32.1% for the acute myeloid leukemia and 45.3% for acute lymphoblastic leukemia patients after salvage therapy, respectively. Grade III-IV acute graft-versus-host disease (GVHD) after transplantation and >20% bone marrow blasts at relapse were associated with worse prOS, while patients with chronic GVHD after transplantation, relapse later than 1 year after transplantation, and solitary extramedullary disease had better prOS. Therefore, we developed a concise risk scoring system for prOS based on the number of risk factors affecting prOS. This scoring system was validated with another cohort of post-transplant relapsed acute leukemia patients who received allo-HSCT between 2019 and 2020. Identifying relapse risk factors and providing personalized care for patients with poor prognoses is crucial for improving survival.