Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation

Christoph Schmid, Myriam Labopin, Arnon Nagler, Dietger Niederwieser, Luca Castagna, Reza Tabrizi, Michael Stadler, Jürgen Kuball, Jan Cornelissen, Jiri Vorlicek, Gerard Socié, Michele Falda, Lars Vindeløv, Per Ljungman, Graham Jackson, Nicolaus Kröger, Andreas Rank, Emmanuelle Polge, Vanderson Rocha, Mohamad Mohty

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Abstract

Because information on management and outcome of AML relapse after allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) is scarce, a retrospective registry study was performed by the Acute LeukemiaWorking Party of EBMT. Among 2815 RIC transplants performed for AML in complete remission (CR) between 1999 and 2008, cumulative incidence of relapse was 32% ± 1%. Relapsed patients (263) were included into a detailed analysis of risk factors for overall survival (OS) and building of a prognostic score. CR was reinduced in 32%; remission duration after transplantation was the only prognostic factor for response (P = .003). Estimated 2-year OS from relapse was 14%, thereby resembling results of AML relapse after standard conditioning. Among variables available at the time of relapse, remission after HSCT>5 months (hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.37-0.67, P <.001), bone marrow blasts less than 27% (HR = 0.53, 95% CI, 0.40-0.72, P <.001), and absence of acute GVHD after HSCT (HR = 0.67, 95% CI, 0.49-0.93, P = .017) were associated with better OS. Based on these factors, 3 prognostic groups could be discriminated, showing OS of 32% ± 7%, 19% ± 4%, and 4% ± 2% at 2 years (P <.0001). Long-term survival was achieved almost exclusively after successful induction of CR by cytoreductive therapy, followed either by donor lymphocyte infusion or second HSCT for consolidation.

Original languageEnglish
Pages (from-to)1599-1606
Number of pages8
JournalBlood
Volume119
Issue number6
DOIs
Publication statusPublished - Feb 9 2012

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ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Schmid, C., Labopin, M., Nagler, A., Niederwieser, D., Castagna, L., Tabrizi, R., Stadler, M., Kuball, J., Cornelissen, J., Vorlicek, J., Socié, G., Falda, M., Vindeløv, L., Ljungman, P., Jackson, G., Kröger, N., Rank, A., Polge, E., Rocha, V., & Mohty, M. (2012). Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation. Blood, 119(6), 1599-1606. https://doi.org/10.1182/blood-2011-08-375840