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Eur J Haematol. 2019 Aug 14. doi: 10.1111/ejh.13315. [Epub ahead of print]

Survival of early posthematopoietic stem cell transplantation relapse of myeloid malignancies.

Author information

1
Department of Hematology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
2
AIMM Therapeutics, Amsterdam, The Netherlands.
3
Cancer Center Amsterdam, Amsterdam, The Netherlands.
4
Department of Hematology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
5
Department of Immunopathology, Sanquin, Amsterdam, The Netherlands.
6
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
7
Department for BioMedical Research, University of Bern, Bern, Switzerland.
8
Department of Hematology, Oncology Center, Isala Klinieken Zwolle, Zwolle, The Netherlands.

Abstract

OBJECTIVE:

Relapse of AML after allogeneic hematopoietic stem cell transplantation (HSCT) has a poor prognosis, and standard of care therapy is lacking. Early (<6 months) relapse is associated with dismal outcome, while the majority of relapses occur early after transplantation. A more precise indication which patients could benefit from reinduction therapy is warranted.

METHODS:

We retrospectively analyzed outcomes of 83 patients with postallogeneic HSCT relapse. Patients were divided based on intention to treat (curative vs supportive care).

RESULTS:

Of the 50 patients treated with curative intent, 44% reached complete remission (CR) upon reinduction chemotherapy, and of these patients, 50% survived. Two survivors reached CR after immunotherapy (donor lymphocyte infusion (DLI), without reinduction chemotherapy). Sixty-nine percent of the survivors had received high-intensity cytarabine treatment, followed by immunologic consolidation. Relapse <3 months after transplantation was predictive for adverse survival (P = .004), but relapse <6 months was not. In fact, >50% of the survivors had a relapse <6 months.

CONCLUSION:

We confirmed the dismal prognosis of postallogeneic HSCT relapse. Importantly, our data demonstrate that patients fit enough to receive high-dose chemotherapy, even when relapse occurred <6 months, had the best chance to obtain durable remissions, in particular when immunologic consolidation was performed after reaching CR.

KEYWORDS:

acute myeloid leukemia; allogeneic hematopoietic stem cell transplantation; graft-versus-leukemia; outcome

PMID:
31411761
DOI:
10.1111/ejh.13315

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