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Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT
- Source :
- Journal of Hematology & Oncology, Vol 12, Iss 1, Pp 1-11 (2019), Journal of Hematology & Oncology
- Publication Year :
- 2019
-
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%). Electronic supplementary material The online version of this article (10.1186/s13045-019-0751-4) contains supplementary material, which is available to authorized users.
- Subjects :
- 0301 basic medicine
Oncology
Male
Cancer Research
Myeloid
Medizin
Leukemia relapse
0302 clinical medicine
Risk Factors
hemic and lymphatic diseases
Survival after relapse
Cumulative incidence
Societies, Medical
Acute leukemia
Hematology
Myeloid leukemia
lcsh:Diseases of the blood and blood-forming organs
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Leukemia, Myeloid, Acute
medicine.anatomical_structure
030220 oncology & carcinogenesis
Female
Adult
medicine.medical_specialty
Adolescent
lcsh:RC254-282
03 medical and health sciences
Young Adult
Sex Factors
Internal medicine
medicine
Humans
ddc:610
Risk factor
Molecular Biology
Aged
Retrospective Studies
lcsh:RC633-647.5
business.industry
Research
Settore MED/15
Survival Analysis
Transplantation
030104 developmental biology
Transplantation, Haploidentical
Bone marrow
Neoplasm Recurrence, Local
business
Stem Cell Transplantation
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Journal of Hematology & Oncology, Vol 12, Iss 1, Pp 1-11 (2019), Journal of Hematology & Oncology
- Accession number :
- edsair.doi.dedup.....def6c12430a57e0360bb0709f9b7b6d8