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.

Table 1.
CHARACTERISTICALL=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) 
CHARACTERISTICALL=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) 
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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.

Disclosures

No relevant conflicts of interest to declare.

Topics:
hematopoietic stem cell transplantation, leukemia, acute, transplantation, allogeneic hematopoietic stem cell transplant, leukemia, abnormal involuntary movement scale, alberta infant motor scales, chemotherapy regimen, did not receive therapy or drug, disease remission

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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