Acute myeloid leukaemia relapsing after allogeneic haemopoietic stem cell transplantation: prognostic factors and impact of initial therapy of relapse

被引:14
作者
Lim, Andrew B. M. [1 ,2 ,13 ]
Curley, Cameron [5 ,13 ]
Fong, Chun Y. [3 ]
Bilmon, Ian [6 ,7 ,14 ]
Beligaswatte, Ashanka [11 ,15 ]
Purtill, Duncan [12 ,16 ]
Getta, Bartlomiej [7 ,17 ]
Johnston, Anne M. [8 ]
Armytage, Tasman [9 ,18 ]
Collins, Marnie [4 ,19 ]
Mason, Kate [1 ]
Fielding, Katherine [1 ]
Greenwood, Matthew [9 ]
Gibson, John [8 ,10 ]
Hertzberg, Mark [7 ,20 ]
Wright, Matthew [12 ,16 ]
Lewis, Ian [11 ]
Moore, John [6 ,14 ]
Curtis, David [3 ,13 ]
Szer, Jeff [1 ,2 ]
Kennedy, Glen [5 ]
Ritchie, David [1 ,2 ]
机构
[1] Royal Melbourne Hosp, Dept Clin Haematol & BMT Serv, Melbourne, Vic, Australia
[2] Univ Melbourne, Melbourne, Vic, Australia
[3] The Alfred, Dept Clin Haematol, Melbourne, Vic, Australia
[4] Ctr Biostat & Clin Trials, Melbourne, Vic, Australia
[5] Royal Brisbane & Womens Hosp, Dept Haematol & BMT, Brisbane, Qld, Australia
[6] St Vincents Hosp, Haematol Dept, Sydney, NSW, Australia
[7] Westmead Hosp, Dept Haematol, Sydney, NSW, Australia
[8] Royal Prince Alfred Hosp, Inst Haematol, Sydney, NSW, Australia
[9] Royal North Shore Hosp, Dept Haematol, Sydney, NSW, Australia
[10] Univ Sydney, Sydney, NSW, Australia
[11] Royal Adelaide Hosp, Clin Haematol Bone Marrow Transplant Unit, Adelaide, SA, Australia
[12] Royal Perth Hosp, Dept Haematol, Perth, WA, Australia
[13] Austin Hlth, Dept Clin Haematol, Melbourne, Vic, Australia
[14] St Vincents Hlth Network, Dept Haematol, Sydney, NSW, Australia
[15] Flinders Med Ctr, Dept Haematol, Adelaide, SA, Australia
[16] Fiona Stanley Hosp, Dept Haematol, Perth, WA, Australia
[17] Mem Sloan Kettering Canc Ctr, Div Leukemia Serv, Hematol Oncol, 1275 York Ave, New York, NY 10021 USA
[18] Gosford Hosp, Cent Coast Reg Canc Ctr, Sydney, NSW, Australia
[19] Univ Melbourne, Sch Math & Stat, Ctr Stat Consulting, Melbourne, Vic, Australia
[20] Prince Wales Hosp, Dept Haematol, Sydney, NSW, Australia
关键词
allogeneic transplantation; acute myeloid leukaemia; relapse; 1ST COMPLETE REMISSION; VERSUS-HOST-DISEASE; CHRONIC GRAFT; WORKING GROUP; ALLO-SCT; AML; RISK; MALIGNANCIES; OUTCOMES; ADULTS;
D O I
10.1111/imj.13522
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background/AimsWe 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. MethodsData 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. ResultsOn 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- 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). ConclusionPatients 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.
引用
收藏
页码:276 / 285
页数:10
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