Central nervous system relapse of leukemia after allogeneic hematopoietic stem cell transplantation.
Little information is available regarding central nervous system (CNS) relapse of adult leukemia after allogeneic hematopoietic stem cell transplantation (HSCT). Therefore, we reviewed the data of 1226 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myelogenous leukemia (CML) who received first allogeneic HSCT between 1994 and 2004, using the database of the Kanto Study Group for Cell Therapy (KSGCT), and analyzed the incidence, risk factors, and outcome of patients with CNS relapse. Twenty-nine patients developed CNS relapse at a median of 296 (9-1677) days after HSCT with a cumulative incidence of 2.3%. Independent significant factors associated with CNS relapse included ALL as the underlying diagnosis (relative risk [RR] = 9.55, 95% confidence interval [CI] = 1.26-72.2, P = .029), nonremission at HSCT (RR = 2.30, 95% CI = 1.03-5.15, P = .042), the history of CNS invasion before HSCT (RR = 5.62, 95% CI = 2.62-12.0, P = 9.2 x 10(-6)), and the prophylactic intrathecal chemotherapy after HSCT (RR = 2.57, 95% CI = 1.21-5.46, P = .014). The 3-year overall survival (OS) after CNS relapse was 18%. In 7 of 29 patients with CNS relapse, leukemia was observed only in CNS. Three of 7 patients were alive without systemic relapse, resulting in 3-year survival after CNS relapse of 46%. Although the outcome of patients with CNS relapse was generally poor, long-term disease-free survival could be achieved in some patients.
Oshima
Kumi
K
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Kanda
Yoshinobu
Y
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan. Electronic address: ycanda-tky@umin.ac.jp.
Yamashita
Takuya
T
Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Takahashi
Satoshi
S
Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Mori
Takehiko
T
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Nakaseko
Chiaki
C
Department of Hematology, Chiba University School of Medicine, Chiba, Japan.
Fujimaki
Katsumichi
K
Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Kanagawa, Japan.
Yokota
Akira
A
Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan.
Fujisawa
Shin
S
Department of Hematology, Yokohama City University Medical Center, Kanagawa, Japan.
Matsushima
Takafumi
T
Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
Fujita
Hiroyuki
H
Division of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan.
Sakura
Tohru
T
Division of Hematology, Saiseikai Maebashi Hospital, Gunma, Japan.
Okamoto
Shinichiro
S
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Maruta
Atsuo
A
Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
Sakamaki
Hisashi
H
Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
D000293:Adolescent; D000328:Adult; D000368:Aged; D016543:Central Nervous System Neoplasms / Q000209:etiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000473:pathology* / Q000628:therapy*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive; D015470:Leukemia, Myeloid, Acute; D017254:Leukemic Infiltration; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome