Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation

• Published in: Blood Vol. 119; no. 6; pp. 1599 - 1606
• Main Authors: Schmid, Christoph, Labopin, Myriam, Nagler, Arnon, Niederwieser, Dietger, Castagna, Luca, Tabrizi, Reza, Stadler, Michael, Kuball, Jürgen, Cornelissen, Jan, Vorlicek, Jiri, Socié, Gerard, Falda, Michele, Vindeløv, Lars, Ljungman, Per, Jackson, Graham, Kröger, Nicolaus, Rank, Andreas, Polge, Emmanuelle, Rocha, Vanderson, Mohty, Mohamad
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 09.02.2012; Americain Society of Hematology
• Subjects: Acute Disease; Adolescent; Adult; Aged; Biological and medical sciences; Europe; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - methods; Humans; Kaplan-Meier Estimate; Leukemia, Myeloid - pathology; Leukemia, Myeloid - surgery; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Prognosis; Recurrence; Registries - statistics & numerical data; Remission Induction; Retrospective Studies; Risk Factors; Transplantation Conditioning - methods; Transplantation, Homologous; Treatment Outcome; Young Adult; Europe; Human; Acute myelogenous leukemia; Relapse; Prognosis; Hematology; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; Non myeloablative treatment; Epidemiology; Treatment; Allogeneic hematopoietic stem cell transplantation; Risk factor; Graft; Adult; Cancer
• DOI: 10.1182/blood-2011-08-375840
• ISSN: 0006-4971; 1528-0020

Because information on management and outcome of AML relapse after allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of EBMT. Among 2815 RIC transplants performed for AML in complete remission (CR) between 1999 and 2008, cumulative incidence of relapse was 32% ± 1%. Relapsed patients (263) were included into a detailed analysis of risk factors for overall survival (OS) and building of a prognostic score. CR was reinduced in 32%; remission duration after transplantation was the only prognostic factor for response (P = .003). Estimated 2-year OS from relapse was 14%, thereby resembling results of AML relapse after standard conditioning. Among variables available at the time of relapse, remission after HSCT > 5 months (hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.37-0.67, P < .001), bone marrow blasts less than 27% (HR = 0.53, 95% CI, 0.40-0.72, P < .001), and absence of acute GVHD after HSCT (HR = 0.67, 95% CI, 0.49-0.93, P = .017) were associated with better OS. Based on these factors, 3 prognostic groups could be discriminated, showing OS of 32% ± 7%, 19% ± 4%, and 4% ± 2% at 2 years (P < .0001). Long-term survival was achieved almost exclusively after successful induction of CR by cytoreductive therapy, followed either by donor lymphocyte infusion or second HSCT for consolidation.