Andrew B M Lim1,2, Cameron Curley3, Chun Y Fong4, Ian Bilmon5,6, Ashanka Beligaswatte7, Duncan Purtill8, Bartlomiej Getta6, Anne M Johnston9, Tasman Armytage10, Marnie Collins11, Kate Mason1, Katherine Fielding1, Matthew Greenwood10, John Gibson9,12, Mark Hertzberg6, Matthew Wright8, Ian Lewis7, John Moore5, David Curtis4, Jeff Szer1,2, Glen Kennedy3, David Ritchie1,2. 1. Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. 2. The University of Melbourne, Melbourne, Victoria, Australia. 3. Department of Haematology and BMT, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 4. Department of Clinical Haematology, The Alfred, Melbourne, Victoria, Australia. 5. Haematology Department, St Vincent's Hospital, Sydney, New South Wales, Australia. 6. Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia. 7. Clinical Haematology Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 8. Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia. 9. Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 10. Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia. 11. Centre for Biostatistics and Clinical Trials, Melbourne, Victoria, Australia. 12. The University of Sydney, Sydney, New South Wales, Australia.
Abstract
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.
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.
Authors: Greta de Jong; Jeroen J W M Janssen; Bart J Biemond; Sacha S Zeerleder; Gert J Ossenkoppele; Otto Visser; Erfan Nur; Ellen Meijer; Mette D Hazenberg Journal: Eur J Haematol Date: 2019-08-14 Impact factor: 2.997