Risk Factors Influencing Outcome of Acute Leukemia Patients Who Experience Relapse After Allogeneic Hematopoietic Stem-Cell Transplantation

In a study of 43 patients to assess the risk factors influencing relapse outcome after hematopoietic stem-cell transplantation in acute leukemia, older age and failure to experience complete remission (CR) after treatment were associated with inferior overall survival. Female sex, extramedullary relapse, and absence of postrelapse graft-versus-host disease (GVHD) were associated with lower CR; and absence of extramedullary relapse, treatment with donor lymphocyte infusion, and occurrence of postrelapse GVHD were associated with higher nonrelapse mortality. Background: Prognosis of acute leukemia patients who experience relapse after hematopoietic stem-cell transplantation (HSCT) remains poor. Identifying risk factors influencing outcome of these patients is essential. Patients and Methods: Follow-up of 234 acute leukemia patients who underwent allogeneic HSCT from matched related donor was performed for occurrence of posttransplantation relapse. Statuses of remission and survival were assessed at 6 months after treatment of relapse. Analysis of risk factors influencing postrelapse overall survival (prOS), complete remission (CR), and nonrelapse mortality (NRM) was carried out. Results: Posttransplantation relapse occurred in 43 patients (17.9%). After treatment, 11 patients (25.6%) experienced postrelapse remission, the prOS rate was 20.9% (9 patients), and the NRM rate was 25.6% (11 patients). Older age (P=.007) and failure to experience remission after relapse treatment (P=.027) were associated with lower prOS in multivariate analysis. Female sex (P=.027), posttransplantation extramedullary relapse (P=.001), and absence of postrelapse graft-versus-host disease P=.025) were associated with lower CR rate. Also, presence of extramedullary relapse (P=.011) was associated with lower risk of NRM whereas treatment of posttransplantation relapse with donor lymphocyte infusion with or without chemotherapy (P=.002) and occurrence of postrelapse graft-versus-host disease (P=.025) were associated with higher risk of NRM. Conclusion: Survival of acute leukemia patients who experience relapse after allogeneic HSCT is poor, especially in elderly patients and those who do not experience remission after relapse treatment. (C) 2018 Elsevier Inc. All rights reserved.