Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT.
Adolescent
Adult
Aged
Female
Humans
Leukemia, Myeloid, Acute
/ epidemiology
Male
Middle Aged
Neoplasm Recurrence, Local
/ etiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ epidemiology
Retrospective Studies
Risk Factors
Sex Factors
Societies, Medical
Stem Cell Transplantation
/ methods
Survival Analysis
Transplantation, Haploidentical
/ methods
Young Adult
Leukemia relapse
Survival after relapse
Journal
Journal of hematology & oncology
ISSN: 1756-8722
Titre abrégé: J Hematol Oncol
Pays: England
ID NLM: 101468937
Informations de publication
Date de publication:
04 07 2019
04 07 2019
Historique:
received:
26
03
2019
accepted:
14
06
2019
entrez:
6
7
2019
pubmed:
6
7
2019
medline:
17
6
2020
Statut:
epublish
Résumé
As information on incidence, risk factors, and outcome of acute leukemia (AL) relapse after unmanipulated haploidentical stem cell transplantation (haplo-SCT) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Among 1652 transplants performed for lymphoblastic and myeloid AL between 2007 and 2014, 587 patients (acute lymphoblastic leukemia (ALL) 131, acute myeloid leukemia (AML) 456) with detailed information were analyzed aiming to identify risk factors for post-transplant relapse and for overall survival (OS) after relapse. The cumulative incidence of relapse at 3 years was 44% (35-53%) for ALL and 32% (27-36%) for AML (p = 0.023). In ALL, risk factors for relapse were disease status different from the first complete remission (CR1) at haplo-SCT (CR2 vs CR1: HR 2.85, p = 0.011; advanced vs CR1: HR 14.28, p < 0.0001) and male donor gender (HR 3.64, p = 0.0002), while in AML, risk factors were advanced disease at haplo-SCT (advanced vs CR1: HR 3.95, p < 0.0001) and comorbidities (HCT-CI) ≥ 3 (HR 1.75, p = 0.014). Transplants performed in more recent years were associated with lower relapse incidence (RI) in AML, but not in ALL (HR 0.91, p = 0.042). After relapse, median follow-up was 13 months (mos). OS at 1-year post relapse was 18%. Prognostic factors for superior OS after relapse were remission at time of haplo-SCT (CR vs advanced: HR 0.71, p = 0.028), time from transplant to relapse (≥ 5 mos vs < 5 mos: HR 0.530, p < 0.0001), and bone marrow as a stem cell source (peripheral blood (PB) vs bone marrow (BM): HR 1.473, p = 0.016). Risk factors for relapse after haploidentical transplantation were disease specific. Longer OS after relapse was achieved in particular by patients both in CR at haplo-SCT and relapsing more than 5 months after transplant (1-year OS 33%).
Sections du résumé
BACKGROUND
As information on incidence, risk factors, and outcome of acute leukemia (AL) relapse after unmanipulated haploidentical stem cell transplantation (haplo-SCT) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
METHODS
Among 1652 transplants performed for lymphoblastic and myeloid AL between 2007 and 2014, 587 patients (acute lymphoblastic leukemia (ALL) 131, acute myeloid leukemia (AML) 456) with detailed information were analyzed aiming to identify risk factors for post-transplant relapse and for overall survival (OS) after relapse.
RESULTS
The cumulative incidence of relapse at 3 years was 44% (35-53%) for ALL and 32% (27-36%) for AML (p = 0.023). In ALL, risk factors for relapse were disease status different from the first complete remission (CR1) at haplo-SCT (CR2 vs CR1: HR 2.85, p = 0.011; advanced vs CR1: HR 14.28, p < 0.0001) and male donor gender (HR 3.64, p = 0.0002), while in AML, risk factors were advanced disease at haplo-SCT (advanced vs CR1: HR 3.95, p < 0.0001) and comorbidities (HCT-CI) ≥ 3 (HR 1.75, p = 0.014). Transplants performed in more recent years were associated with lower relapse incidence (RI) in AML, but not in ALL (HR 0.91, p = 0.042). After relapse, median follow-up was 13 months (mos). OS at 1-year post relapse was 18%. Prognostic factors for superior OS after relapse were remission at time of haplo-SCT (CR vs advanced: HR 0.71, p = 0.028), time from transplant to relapse (≥ 5 mos vs < 5 mos: HR 0.530, p < 0.0001), and bone marrow as a stem cell source (peripheral blood (PB) vs bone marrow (BM): HR 1.473, p = 0.016).
CONCLUSIONS
Risk factors for relapse after haploidentical transplantation were disease specific. Longer OS after relapse was achieved in particular by patients both in CR at haplo-SCT and relapsing more than 5 months after transplant (1-year OS 33%).
Identifiants
pubmed: 31272508
doi: 10.1186/s13045-019-0751-4
pii: 10.1186/s13045-019-0751-4
pmc: PMC6610936
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
68Références
Bone Marrow Transplant. 2015 Dec;50(12):1508-12
pubmed: 26389832
Haematologica. 2010 Jun;95(6):860-3
pubmed: 20513805
Biol Blood Marrow Transplant. 2014 Dec;20(12):2023-8
pubmed: 25196855
Biol Blood Marrow Transplant. 2003 Apr;9(4):215-33
pubmed: 12720215
Leuk Lymphoma. 2006 Sep;47(9):1754-67
pubmed: 17064985
Biol Blood Marrow Transplant. 2008 Jun;14(6):641-50
pubmed: 18489989
Blood. 2008 Feb 15;111(4):1827-33
pubmed: 18048644
J Clin Oncol. 2013 Sep 10;31(26):3259-71
pubmed: 23918951
Cochrane Database Syst Rev. 2011 Oct 05;(10):CD008818
pubmed: 21975786
Leukemia. 2015 May;29(5):1143-52
pubmed: 25371177
Leukemia. 2016 Feb;30(2):447-55
pubmed: 26293645
Bone Marrow Transplant. 2019 Sep;54(9):1462-1470
pubmed: 30710101
J Clin Oncol. 2011 Feb 10;29(5):532-43
pubmed: 21220592
Haematologica. 2017 Feb;102(2):391-400
pubmed: 27846611
Blood. 2014 Oct 23;124(17):2735-43
pubmed: 25214441
Biol Blood Marrow Transplant. 2014 Dec;20(12):1975-81
pubmed: 25263628
Biol Blood Marrow Transplant. 2018 Jan;24(1):119-126
pubmed: 29024804
Int J Hematol. 2018 Feb;107(2):138-150
pubmed: 29143282
Eur J Haematol. 2013 Oct;91(4):304-14
pubmed: 23837640
Bone Marrow Transplant. 1995 Jun;15(6):825-8
pubmed: 7581076
Biol Blood Marrow Transplant. 2016 Jun;22(6):982-990
pubmed: 26785334
Leukemia. 2015 Feb;29(2):396-405
pubmed: 24897508
Biol Blood Marrow Transplant. 2009 Feb;15(2):257-65
pubmed: 19167686
Bone Marrow Transplant. 2019 Aug;54(8):1198-1207
pubmed: 30518981
Bone Marrow Transplant. 2012 May;47(5):669-76
pubmed: 21860427
Bone Marrow Transplant. 2002 Dec;30(12):861-6
pubmed: 12476277
Clin Cancer Res. 2018 Jun 15;24(12):2794-2803
pubmed: 29555662
Eur J Haematol. 2016 Jun;96(6):629-36
pubmed: 26260140
Exp Hematol. 2017 Apr;48:1-11
pubmed: 28027963
Biol Blood Marrow Transplant. 2013 Jan;19(1):117-22
pubmed: 22940057
Blood. 2005 Oct 15;106(8):2912-9
pubmed: 15994282
Eur J Haematol. 2017 Apr;98(4):348-354
pubmed: 27893163
J Clin Oncol. 2007 Nov 1;25(31):4938-45
pubmed: 17909197
Biol Blood Marrow Transplant. 2018 Feb;24(2):343-352
pubmed: 29055682
Cancer. 2018 Apr 1;124(7):1428-1437
pubmed: 29360162
J Hematol Oncol. 2016 Mar 15;9:25
pubmed: 26980295
Bone Marrow Transplant. 2019 Nov;54(11):1815-1826
pubmed: 31089280
J Hematol Oncol. 2017 May 30;10(1):113
pubmed: 28558762
Haematologica. 2018 Aug;103(8):1317-1328
pubmed: 29748438
J Clin Oncol. 2013 Apr 1;31(10):1310-6
pubmed: 23423745
Transpl Int. 2011 May;24(5):469-76
pubmed: 21294789
Blood. 1995 Sep 1;86(5):2041-50
pubmed: 7655033
Biol Blood Marrow Transplant. 2017 Jul;23(7):1087-1094
pubmed: 28396161
J Clin Oncol. 2017 Sep 10;35(26):3002-3009
pubmed: 28644773
Leukemia. 2012 Jun;26(6):1211-7
pubmed: 22290066
Blood. 2015 Aug 20;126(8):1033-40
pubmed: 26130705
Haematologica. 2017 Feb;102(2):401-410
pubmed: 27758821
Bone Marrow Transplant. 2016 Jul;51(7):949-54
pubmed: 26999464
Leukemia. 2019 Jan;33(1):230-239
pubmed: 29907809
Bone Marrow Transplant. 1992 Apr;9(4):269-75
pubmed: 1600415
J Hematol Oncol. 2017 Jan 19;10(1):24
pubmed: 28103944
Blood. 2013 Jan 31;121(5):849-57
pubmed: 23165479
Biol Blood Marrow Transplant. 2017 Oct;23(10):1736-1743
pubmed: 28688919