Acute myeloid leukaemia relapsing after allogeneic haemopoietic stem cell transplantation: prognostic factors and impact of initial therapy of relapse.

Autor: Lim ABM; Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; The University of Melbourne, Melbourne, Victoria, Australia., Curley C; Department of Haematology and BMT, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia., Fong CY; Department of Clinical Haematology, The Alfred, Melbourne, Victoria, Australia., Bilmon I; Haematology Department, St Vincent's Hospital, Sydney, New South Wales, Australia.; Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia., Beligaswatte A; Clinical Haematology Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Purtill D; Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia., Getta B; Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia., Johnston AM; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia., Armytage T; Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia., Collins M; Centre for Biostatistics and Clinical Trials, Melbourne, Victoria, Australia., Mason K; Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Fielding K; Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Greenwood M; Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia., Gibson J; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; The University of Sydney, Sydney, New South Wales, Australia., Hertzberg M; Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia., Wright M; Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia., Lewis I; Clinical Haematology Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Moore J; Haematology Department, St Vincent's Hospital, Sydney, New South Wales, Australia., Curtis D; Department of Clinical Haematology, The Alfred, Melbourne, Victoria, Australia., Szer J; Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; The University of Melbourne, Melbourne, Victoria, Australia., Kennedy G; Department of Haematology and BMT, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia., Ritchie D; Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; The University of Melbourne, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2018 Mar; Vol. 48 (3), pp. 276-285.
DOI: 10.1111/imj.13522
Abstrakt: Background/aims: We sought to determine factors associated with the overall survival from relapse (OSR) of acute myeloid leukaemia (AML) after allogeneic haemopoietic stem cell transplantation (alloHSCT) and the effect of first salvage therapy and subsequent graft-versus-host disease (GVHD) on OSR.
Methods: Data on 386 patients from nine Australian centres with relapsed AML post-alloHSCT were collected retrospectively. OSR was calculated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted using the log-rank test and proportional hazards modelling, respectively and a prognostic index for OSR was derived from multivariate modelling.
Results: On multivariate analysis, relapse within 6 months (hazard ratio (HR) 2.4, P < 0.001) and grade 3-4 acute GVHD preceding relapse (HR 2.0, P = 0.004), were associated with inferior OSR. Patients with 1-2 factors had inferior OSR compared to those with zero factors (all patients: HR 2.3, P < 0.001, patients given salvage: HR 1.8, P < 0.001). The first salvage therapy used post-relapse was donor cell therapy (DCT) (second alloHSCT or donor lymphocyte infusion) in 75, re-induction chemotherapy (CT) in 103, radiotherapy in 8 and interferon-α in 6. Although re-induction CT death rate was low (2%), survival after CT was inferior to DCT (HR 1.9, P < 0.001). No survival benefit was seen for patients who developed GVHD following salvage therapy (P = 0.405).
Conclusion: Patients with AML who relapse beyond 6 months from alloHSCT without prior grade 3-4 acute GVHD have a better outcome from salvage therapy. Salvage treatments employing DCT as the initial treatment of AML relapse confer a survival advantage over CT.
(© 2017 Royal Australasian College of Physicians.)
Databáze: MEDLINE
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