[HTML][HTML] Outcomes of adults with acute lymphoblastic leukemia relapsing after allogeneic hematopoietic stem cell transplantation

LM Poon, A Hamdi, R Saliba, G Rondon… - Biology of Blood and …, 2013 - Elsevier
LM Poon, A Hamdi, R Saliba, G Rondon, C Ledesma, M Kendrick, M Qazilbash, C Hosing…
Biology of Blood and Marrow Transplantation, 2013Elsevier
For patients with acute lymphoblastic leukemia (ALL) who relapse after allogeneic
hematopoietic stem cell transplantation (HSCT), treatment options are limited, and the
clinical course and prognostic factors affecting outcome have not been well characterized.
We retrospectively analyzed outcomes of 123 adult patients with ALL who relapsed after a
first HSCT performed at our center between 1993 and 2011. First-line salvage included
second HSCT (n= 19), donor lymphocyte infusion with or without prior chemotherapy (n …
For patients with acute lymphoblastic leukemia (ALL) who relapse after allogeneic hematopoietic stem cell transplantation (HSCT), treatment options are limited, and the clinical course and prognostic factors affecting outcome have not been well characterized. We retrospectively analyzed outcomes of 123 adult patients with ALL who relapsed after a first HSCT performed at our center between 1993 and 2011. First-line salvage included second HSCT (n = 19), donor lymphocyte infusion with or without prior chemotherapy (n = 11), radiation therapy (n = 6), cytoreductive chemotherapy (n = 30), mild chemotherapy (n = 27), or palliative care (n = 23), with median postrelapse overall survival (OS) of 10 months, 6.5 months, 3 months, 4 months, 4 months, and 1 month, respectively. Despite a complete remission rate of 38% after first-line salvage in the treated patients, the OS rate remained limited with 1- and 2- year OS rates of 17% (95% confidence interval, 13 to 29) and 10% (95% confidence interval, 6 to 20), respectively. On univariate analysis, adverse factors for OS included active disease at the time of first HSCT and short time to progression from first HSCT (<6 months). There was no difference in the 6-month survival postrelapse in patients with isolated extramedullary relapse (44%) compared with combined extramedullary and bone marrow relapse (29%) or those with isolated bone marrow relapse (34%) (P = .8). Our data provide more insight into the disease behavior and treatment outcomes of ALL at relapse after HSCT against which future trials may be compared.
Elsevier