Abstract
BACKGROUND
In recent decades the results in the treatment of acute leukemia's have improved, this due to the optimization of chemotherapy regimens, risk stratification, monitoring of minimal residual disease, development of new agents and best supportive care.
Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk of relapse. Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk relapse. However, patients who relapse after transplantation have a poor prognosis because of subsequent treatments do not confer a success survival. The EBMT has reported a 5.5 months median survival after relapse, overall survival of 8% of ALL and 10-20% to AML to 3 years.
AIMS
Report outcomes of patients with relapsed acute leukemia after hematopoietic stem cell transplantation (HSCT).
METHODS
Retrospective analysis of our hematopoietic stem cell transplantation database was undertaken, containing 81 patients with acute leukemia presenting of a period of 10 years.
RESULTS
We Identified 81 patients, 47 (58%) were men. Median age for ALL was 20 years (7-55 yr) and for AML patients was 34 (15-64yr). ALL was the most frequent diagnosis (61%), 28 patients had AML (35%), other leukemias (4%). 44% patients with ALL had Ph'Chr+.
60% of all patients underwent myeloablative regimen transplantation in first CR and 30% in second remission. The 95% of HSCT was performed allogeneic transplantation and the rest was autologous. In most cases the source of stem cells was peripheral blood.
Post-transplant relapse occurred in 51% and 54% of patients with ALL and AML, 10 and 12 months respectively. A total of 6 patients was underwent to second transplant with reduce intensity regimen with very poor response. Table 1 was shows the principal features of patients.
| CHARACTERISTIC . | ALL=49 % (n) . | AML =28 % (n) . | Other leukemia =3 % (n) . |
|---|---|---|---|
| Age at HSCT Median (Range) | 22 (15-55) | 34 (17-64) | 18 (16-35) |
| Response before HSCT | |||
| First CR | 63 (31) | 53 (15) | 100 (3) |
| Second CR | 29 (14) | 36 (10) | 0 |
| Third or more CR | 2 (1) | 4 (1) | 0 |
| Active disease | 2 (1) | 7 (2) | 0 |
| Allogeneic | 98% (48) | 93 (26) | 66.7 (2) |
| Autologous | 2 (1) | 7.1 (2) | 33.2 (1) |
| GVHD | |||
| Acute | 26.5 (13) | 17.9 (5) | 22.2 (1) |
| Chronic | 22.9 (11) | 39.3 (11) | 0 |
| Relapsed Media time at relapsed | 51 (25) 10 months | 53.6 (15) 12 months | 66.7 (2) |
| Post-Relapse Treatment Without treatment Palliative CT Cytotoxic CT | 32 (8) 24 (6) 44 (11) | 26.7 (4) 13.3 (2) 60 (9) | 0 100 (2) |
| Response after re-induction CT CR Active disease | 20 (5) 48 (12) 32 (8) | 33.3 (5) 33.3 (5) 33.3 (5) | 0 100 (2) 0 |
| Second HSCT | 4.1 (2) | 14.3 (4) | |
| Relapsed at second HSCT | 50 (1) | 50 (2) | |
| Outcome Alive Dead | 55.1 (27) 44.9 (22) | 39.3 (11) 60.7 (17) | 33.3 (1) 66.7 (2) |
| 3-years OS 5-years OS Median | 56% 43% 50 months | A 3 years 44% A 5 years 34% 36 months | 20 months |
| RFS 1-year Median | 56% 22 months | 28% 5 Months | 33% 10 months |
| NRM Mortality to relapse | 9.5 (2) 90.5 (19) | 23.5 (4) 76.5 (13) | O 100 (2) |
| CHARACTERISTIC . | ALL=49 % (n) . | AML =28 % (n) . | Other leukemia =3 % (n) . |
|---|---|---|---|
| Age at HSCT Median (Range) | 22 (15-55) | 34 (17-64) | 18 (16-35) |
| Response before HSCT | |||
| First CR | 63 (31) | 53 (15) | 100 (3) |
| Second CR | 29 (14) | 36 (10) | 0 |
| Third or more CR | 2 (1) | 4 (1) | 0 |
| Active disease | 2 (1) | 7 (2) | 0 |
| Allogeneic | 98% (48) | 93 (26) | 66.7 (2) |
| Autologous | 2 (1) | 7.1 (2) | 33.2 (1) |
| GVHD | |||
| Acute | 26.5 (13) | 17.9 (5) | 22.2 (1) |
| Chronic | 22.9 (11) | 39.3 (11) | 0 |
| Relapsed Media time at relapsed | 51 (25) 10 months | 53.6 (15) 12 months | 66.7 (2) |
| Post-Relapse Treatment Without treatment Palliative CT Cytotoxic CT | 32 (8) 24 (6) 44 (11) | 26.7 (4) 13.3 (2) 60 (9) | 0 100 (2) |
| Response after re-induction CT CR Active disease | 20 (5) 48 (12) 32 (8) | 33.3 (5) 33.3 (5) 33.3 (5) | 0 100 (2) 0 |
| Second HSCT | 4.1 (2) | 14.3 (4) | |
| Relapsed at second HSCT | 50 (1) | 50 (2) | |
| Outcome Alive Dead | 55.1 (27) 44.9 (22) | 39.3 (11) 60.7 (17) | 33.3 (1) 66.7 (2) |
| 3-years OS 5-years OS Median | 56% 43% 50 months | A 3 years 44% A 5 years 34% 36 months | 20 months |
| RFS 1-year Median | 56% 22 months | 28% 5 Months | 33% 10 months |
| NRM Mortality to relapse | 9.5 (2) 90.5 (19) | 23.5 (4) 76.5 (13) | O 100 (2) |
CONCLUSION
Our results confirm that treatment options for high risk acute leukemic patients who relapse early after HSCT are limited with extremely poor prognosis, special in patient relapsed early post-transplant. More studies are needed to determinate the best treatment option for patient who relapse after HSCT.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
