title: Outcomes of patients with acute leukaemia who relapsed after reduced-intensity stem cell transplantation from HLA-identical or one antigen-mismatched related donors.
abstract: The characteristics of relapse following reduced-intensity stem-cell transplantation (RIST) remain to be clarified. We reviewed the medical records of 19 patients with acute leukaemia [acute myeloid leukaemia (AML), 16; acute lymphoblastic leukaemia (ALL), 3] who relapsed after RIST from related donors using purine-analogue-based regimens. Their median age was 55 years (range, 29-65 years). Median interval between RIST and relapse was 4.9 months (range, 1.8-24.9 months). Three chose not to receive interventions. The remaining 16 patients received withdrawal of immunosuppression (n = 3), chemotherapy (n = 2), donor lymphocyte infusion (n = 10) and second transplantation (n = 7), alone (n = 9) or in combination (n = 7). Four are alive with a median follow-up of 27.6 months (range, 16.0-28.9 months); three in remission and one in relapse. The 2-year overall survival after relapse was 28.9%. Causes of death in 15 patients included progressive disease (n = 7), graft-versus-host disease (n = 5) and infections (n = 3). Cumulative incidences of relapse-related and non-relapse-related deaths at 2 years after relapse were 37% and 32% respectively. Two prognostic factors were identified on univariate analysis: age [P = 0.017; hazard ratio (HR), 1.16; 95% confidence interval (CI), 1.03-1.32], and ALL as underlying disease (P = 0.011; HR, 10.4; 95% CI, 1.73-62.4). Some AML patients who relapse after RIST achieve durable remission with allogeneic immunotherapy-based interventions; however they carry a significant risk of non-relapse mortality.
authors.affiliation: Haematopoietic Stem Cell Transplantation Unit, the National Cancer Centre Hospital, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusumi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Akiko
authors.initials: A
authors.lastname: Hori
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.forename: Shigeru
authors.initials: S
authors.lastname: Masuo
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Mitamura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006680:HLA Antigens / Q000032:analysis*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens