Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC.

Autor: Kaphan E; Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France. Electronic address: eleonore.kaphan@aphp.fr., Bettega F; Department of Clinical Research, Inserm, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France., Forcade E; Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France., Labussière-Wallet H; Department of Hematology-Transplantation, CHU Lyon Sud, Pierre-Bénite, France., Fegueux N; Department of Hematology, CHU Montpellier, Montpellier, France., Robin M; Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France., Peffault De Latour R; Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France., Huynh A; Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France., Lapierre L; Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France., Berceanu A; Department of Intensive Care and Transplantation, CHU Jean Minjoz, Besançon, France., Marcais A; Department of Hematology, Hôpital Necker, Paris, France., Debureaux PE; Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France., Vanlangendonck N; Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium., Bulabois CE; Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France., Magro L; Department of Hematology-Transplantation, CHRU Lille, Lille, France., Daniel A; Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium., Galtier J; Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France., Lioure B; Department of Hematology, CHRU Strasbourg, Strasbourg, France., Chevallier P; Department of Hematology, CHU Nantes, Nantes, France., Antier C; Department of Hematology, CHU Nantes, Nantes, France., Loschi M; Department of Hematology-Transplantation, CHU Nice, Nice, France., Guillerm G; Department of Hematology, CHRU Brest, Brest, France., Mear JB; Department of Hematology-Transplantation, Hôpital de Rennes, Rennes, France., Chantepie S; Basse-Normandie Hematology Institute, CHU Caen, Caen, France., Cornillon J; Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France., Rey G; Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France., Poire X; Department of Hematology, CHU Saint-Luc, Brussels, Belgium., Bazarbachi A; Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon., Rubio MT; Department of Hematology, CHU Nancy, Nancy, France., Contentin N; Department of Hematology, Centre Henri Becquerel, Rouen, France., Orvain C; Department of Hematology-Transplantation, CHU Angers, Angers, France., Dulery R; Department of Clinical Hematology, CHU St Antoine, APHP, Paris, France., Bay JO; Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France., Croizier C; Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France., Beguin Y; Department of Hematology, University of Liège, Liège, Belgium., Charbonnier A; Department of Hematology-Transplantation, CHU Amiens, Amiens, France., Skrzypczak C; Department of Hematology-Transplantation, CHU Amiens, Amiens, France., Desmier D; Department of Hematology, CHU Poitiers, Poitiers, France., Villate A; Department of Hematology, CHRU Tours, Tours, France., Carré M; Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France., Thiebaut-Bertrand A; Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2023 Jun; Vol. 29 (6), pp. 362.e1-362.e12. Date of Electronic Publication: 2023 Feb 26.
DOI: 10.1016/j.jtct.2023.02.020
Abstrakt: Late relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity.
(Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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