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

Authors

SCHMID Christoph LABOPIN Myriam NAGLER Arnon NIEDERWIESER Dietger CASTAGNA Luca TABRIZI Reza STADLER Michael KUBALL Juergen CORNELISSEN Jan VORLÍČEK Jiří SOCIÉ Gerard FALDA Michele VINDELOV Lars LJUNGMAN Per JACKSON Graham KROEGER Nicolaus RANK Andreas POLGE Emmanuelle ROCHA Vanderson MOHTY Mohamad

Year of publication 2012
Type Article in Periodical
Magazine / Source Blood
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1182/blood-2011-08-375840
Field Oncology and hematology
Keywords ACUTE MYELOID-LEUKEMIA; BONE-MARROW-TRANSPLANTATION; 1ST INTERNATIONAL WORKSHOP; GRAFT-VERSUS-LEUKEMIA; LOW-DOSE AZACITIDINE; MYELODYSPLASTIC SYNDROMES; HEMATOLOGIC MALIGNANCIES; MYELOABLATIVE THERAPY; PATIENTS OLDER; WORKING PARTY
Attached files
Description 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.