Outcomes among patients with recurrent high-risk hematologic malignancies after allogeneic hematopoietic cell transplantation.
We retrospectively analyzed outcomes among 307 consecutive patients who had recurrent or persistent acute leukemia (n = 244), chronic myelogenous leukemia in blast phase (CML; n = 28), or advanced myelodysplastic syndromes (MDS; n = 35) after allogeneic hematopoietic cell transplantation and who received at least 1 relapse-directed intervention: withdrawal of immunosuppression, chemotherapy, or donor lymphocyte infusion (DLI). Transplants were performed at a single institution between 1995 and 2004, and outcomes were analyzed according to time intervals from transplantation to detection of malignancy: "early," <100 days (n = 111); "intermediate," 100-200 days (n = 73); and "late," >200 days (n = 123). The overall remission rate was 30%. Compared to early recurrence, intermediate recurrence and late recurrence were associated with increasing probabilities of remission (hazard ratios, 1.89 and 2.16; P = .05 and .02) and decreasing risks of overall mortality (hazard ratios, 0.73 and 0.33; P = .05 and <.0001). The 2-year overall survival (OS) estimates for patients with early, intermediate, and late recurrence were 3%, 9%, and 19%, respectively. Remission was associated with a median survival prolongation of 9.5 months. Individual types or combinations of these nonrandomly assigned relapse-directed interventions were not associated with higher or lower probabilities of remission or survival. More effective intervention strategies are needed for treatment of recurrent high-risk hematologic malignancies after hematopoietic cell transplantation. In the absence of innovative clinical trials, patients with early recurrence might wish to forego further interventions in favor of palliative care.
Mielcarek
Marco
M
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. mmielcar@fhcrc.org
Storer
Barry E
BE
Flowers
Mary E D
ME
Storb
Rainer
R
Sandmaier
Brenda M
BM
Martin
Paul J
PJ
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects; D014861:Washington / Q000453:epidemiology