Allogeneic stem cell transplantation following relapse post autologous stem cell transplantation in adult patients with acute myeloid leukemia: A retrospective analysis of 537 patients from the Acute Leukemia Working Party of the EBMT

Maximilian Christopeit, Myriam Labopin, Norbert Claude Gorin, Francesco Saraceni, Jakob Passweg, Edouard Forcade, Johan Maertens, Maria Teresa Van Lint, Alberto Bosi, Dietger Niederwieser, Gerhard Ehninger, Emmanuelle Polge, Mohamad Mohty, Arnon Nagler

Research output: Contribution to journalArticle

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Abstract

Patients with acute myeloid leukemia (AML) who relapse after autologous stem cell transplantation (ASCT) can be rescued by allogeneic SCT. We identified 537 adult patients with AML allografted in second complete remission (CR2) or first relapse after ASCT in the European Society for Blood and Marrow Transplantation (EBMT) registry. At 3 years post allograft, leukemia free survival (LFS) was 31.4% [95%CI 27.3-35.6], overall survival (OS) 39.5% [95%CI 35.1-43.9], relapse incidence (RI) 34.6% [95%CI 30.4-38.8], and nonrelapse mortality (NRM) 33.7% [95%CI 29.6-37.9]. RI was higher in patients transplanted in relapse in comparison to those transplanted in CR2 (HR 1.76, P =.004) and in patients who relapsed later after ASCT (HR 0.97 per month, P < 10−3), both translating into better LFS/ OS. Relapse was also lower in patients undergoing allogeneic stem cell transplantation (allo-HSCT) from an unrelated donor (UD) in comparison to those transplanted from a matched sibling donor (MSD) (HR 0.49, P < 10−3). NRM was increased in patients who received total body irradiation (TBI) pre-ASCT (HR 2.43; P < 10-4), translating into worse LFS/OS. LFS/OS did not differ between patients allotransplanted with reduced intensity (RIC) or myeloablative (MAC) conditioning. In conclusion, one third of adult patients with AML relapsing post ASCT can be rescued with allo-HSCT, with better LFS/OS in patients who relapsed later post ASCT, those transplanted in CR2 and those who had not received TBI pre-ASCT.

Original languageEnglish
Pages (from-to)1532-1542
Number of pages11
JournalAmerican Journal of Hematology
Volume93
Issue number12
DOIs
Publication statusPublished - Dec 1 2018

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Stem Cell Transplantation
Acute Myeloid Leukemia
Leukemia
Transplantation
Bone Marrow
Recurrence
Survival
Whole-Body Irradiation
Unrelated Donors
Mortality
Incidence
Allografts
Registries
Siblings
Tissue Donors

ASJC Scopus subject areas

  • Hematology

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Allogeneic stem cell transplantation following relapse post autologous stem cell transplantation in adult patients with acute myeloid leukemia : A retrospective analysis of 537 patients from the Acute Leukemia Working Party of the EBMT. / Christopeit, Maximilian; Labopin, Myriam; Gorin, Norbert Claude; Saraceni, Francesco; Passweg, Jakob; Forcade, Edouard; Maertens, Johan; Van Lint, Maria Teresa; Bosi, Alberto; Niederwieser, Dietger; Ehninger, Gerhard; Polge, Emmanuelle; Mohty, Mohamad; Nagler, Arnon.

In: American Journal of Hematology, Vol. 93, No. 12, 01.12.2018, p. 1532-1542.

Research output: Contribution to journalArticle

Christopeit, Maximilian ; Labopin, Myriam ; Gorin, Norbert Claude ; Saraceni, Francesco ; Passweg, Jakob ; Forcade, Edouard ; Maertens, Johan ; Van Lint, Maria Teresa ; Bosi, Alberto ; Niederwieser, Dietger ; Ehninger, Gerhard ; Polge, Emmanuelle ; Mohty, Mohamad ; Nagler, Arnon. / Allogeneic stem cell transplantation following relapse post autologous stem cell transplantation in adult patients with acute myeloid leukemia : A retrospective analysis of 537 patients from the Acute Leukemia Working Party of the EBMT. In: American Journal of Hematology. 2018 ; Vol. 93, No. 12. pp. 1532-1542.
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abstract = "Patients with acute myeloid leukemia (AML) who relapse after autologous stem cell transplantation (ASCT) can be rescued by allogeneic SCT. We identified 537 adult patients with AML allografted in second complete remission (CR2) or first relapse after ASCT in the European Society for Blood and Marrow Transplantation (EBMT) registry. At 3 years post allograft, leukemia free survival (LFS) was 31.4{\%} [95{\%}CI 27.3-35.6], overall survival (OS) 39.5{\%} [95{\%}CI 35.1-43.9], relapse incidence (RI) 34.6{\%} [95{\%}CI 30.4-38.8], and nonrelapse mortality (NRM) 33.7{\%} [95{\%}CI 29.6-37.9]. RI was higher in patients transplanted in relapse in comparison to those transplanted in CR2 (HR 1.76, P =.004) and in patients who relapsed later after ASCT (HR 0.97 per month, P < 10−3), both translating into better LFS/ OS. Relapse was also lower in patients undergoing allogeneic stem cell transplantation (allo-HSCT) from an unrelated donor (UD) in comparison to those transplanted from a matched sibling donor (MSD) (HR 0.49, P < 10−3). NRM was increased in patients who received total body irradiation (TBI) pre-ASCT (HR 2.43; P < 10-4), translating into worse LFS/OS. LFS/OS did not differ between patients allotransplanted with reduced intensity (RIC) or myeloablative (MAC) conditioning. In conclusion, one third of adult patients with AML relapsing post ASCT can be rescued with allo-HSCT, with better LFS/OS in patients who relapsed later post ASCT, those transplanted in CR2 and those who had not received TBI pre-ASCT.",
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AU - Labopin, Myriam

AU - Gorin, Norbert Claude

AU - Saraceni, Francesco

AU - Passweg, Jakob

AU - Forcade, Edouard

AU - Maertens, Johan

AU - Van Lint, Maria Teresa

AU - Bosi, Alberto

AU - Niederwieser, Dietger

AU - Ehninger, Gerhard

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