Extramedullary relapse after allogeneic bone marrow transplantation for haematological malignancy.
We describe the risk factors for and the natural history and response to treatment of extramedullary (EM) relapse in 183 patients who underwent allogeneic bone marrow transplantation (alloBMT) for a variety of haematological malignancies at our institution over a 7 1/2 year period. Fifty-one patients relapsed; 15 had EM relapse either alone or in association with marrow involvement. A retrospective analysis found that the presence of chronic GVHD and a longer interval between transplant and relapse were independently associated with an increased risk of EM compared to marrow-only relapse. EM relapse was also associated with a longer post-relapse survival. Patients with EM relapse appeared to respond to cytotoxic therapy but not to DLI. EM relapse after alloBMT may be more common than previously thought and have a better prognosis than marrow-only relapse. While patients developing chronic GVHD after alloBMT have a lower overall relapse risk than those who do not, they may be more prone to delayed relapse at EM sites.
Chong
G
G
Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Byrnes
G
G
Szer
J
J
Grigg
A
A
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D001842:Bone and Bones / Q000473:pathology; D001940:Breast / Q000473:pathology; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008578:Meninges / Q000473:pathology; D008875:Middle Aged; D009305:Nasopharynx / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D013737:Testis / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D017211:Treatment Failure