Clinical outcomes of AML patients relapsing after matched-related donor and umbilical cord blood transplantation

AML relapse remains the leading cause of transplant failure among Allo-SCT recipients. A single institution study was conducted on 348 patients,with AML who received an Allo-SCT from an umbilical cord blood (UCB, 222) or HLA-matched-related (RD, 126) donor between 2000-2011. Relapse after Allo-SCT occurred in 72 UCB and 32 RD transplant recipients. Three patients achieved CR after withdrawal of immune suppression with no further therapy. Fifty-two patients received intensive post-relapse therapy, defined as systemic chemotherapy (22 UCB, 7 RD), second Allo-SCT (nine UCB, two RD), or DLI +/- systemic chemotherapy (0 UCB, 12 RD); of these, 25% achieved CR (21% UCB vs 35% RD, P = 0.16). Survival at 1 year after relapse was 22% for all patients (19% UCB vs 28% RD, P = 0.36). In multivariable analysis, post-relapse mortality was lower in patients receiving intensive therapy for relapse (hazard ratio (HR) = 0.4; 95% confidence interval (CI) 0.2-0.6, P < 0.01) and higher in patients with peripheral blood blasts above the median (HR = 3.8; 95% CI 2.2-6.6, P < 0.01), active infection (HR = 1.9; 95% CI 1.0-3.5, P = 0.05) and non-infectious medical complications (HR = 2.0; 95% CI 1.2-3.5, P = 0.01). In conclusion, patients with AML relapsing after Allo-SCT who were in good-enough clinical condition to receive intensive therapy had superior short-term survival.