Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT

Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Research output: Contribution to journalArticle

Abstract

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%).

Original languageEnglish
Pages (from-to)68
JournalJournal of Hematology and Oncology
Volume12
Issue number1
DOIs
Publication statusPublished - Jul 4 2019

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Statistical Factor Analysis
Leukemia
Transplantation
Recurrence
Stem Cell Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Transplants
Survival
Bone Marrow
Incidence
Registries
Comorbidity
Retrospective Studies
Tissue Donors

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Leukemia relapse following unmanipulated haploidentical transplantation : a risk factor analysis on behalf of the ALWP of the EBMT. / Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT).

In: Journal of Hematology and Oncology, Vol. 12, No. 1, 04.07.2019, p. 68.

Research output: Contribution to journalArticle

Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). / Leukemia relapse following unmanipulated haploidentical transplantation : a risk factor analysis on behalf of the ALWP of the EBMT. In: Journal of Hematology and Oncology. 2019 ; Vol. 12, No. 1. pp. 68.
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title = "Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT",
abstract = "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{\%}).",
author = "{Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)} and Simona Piemontese and Ariane Boumendil and Myriam Labopin and Christoph Schmid and Fabio Ciceri and William Arcese and Yener Koc and Zafar Gulbas and Johanna Tischer and Benedetto Bruno and Depei Wu and Didier Blaise and Dietrich Beelen and Giuseppe Irrera and Annalisa Ruggeri and Mohamed Houhou and Mohamad Mohty and Arnon Nagler",
year = "2019",
month = "7",
day = "4",
doi = "10.1186/s13045-019-0751-4",
language = "English",
volume = "12",
pages = "68",
journal = "Journal of Hematology and Oncology",
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TY - JOUR

T1 - Leukemia relapse following unmanipulated haploidentical transplantation

T2 - a risk factor analysis on behalf of the ALWP of the EBMT

AU - Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

AU - Piemontese, Simona

AU - Boumendil, Ariane

AU - Labopin, Myriam

AU - Schmid, Christoph

AU - Ciceri, Fabio

AU - Arcese, William

AU - Koc, Yener

AU - Gulbas, Zafar

AU - Tischer, Johanna

AU - Bruno, Benedetto

AU - Wu, Depei

AU - Blaise, Didier

AU - Beelen, Dietrich

AU - Irrera, Giuseppe

AU - Ruggeri, Annalisa

AU - Houhou, Mohamed

AU - Mohty, Mohamad

AU - Nagler, Arnon

PY - 2019/7/4

Y1 - 2019/7/4

N2 - 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%).

AB - 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%).

U2 - 10.1186/s13045-019-0751-4

DO - 10.1186/s13045-019-0751-4

M3 - Article

C2 - 31272508

VL - 12

SP - 68

JO - Journal of Hematology and Oncology

JF - Journal of Hematology and Oncology

SN - 1756-8722

IS - 1

ER -