Allogeneic hematopoietic cell transplantation for acute leukemia in first relapse or second remission.
BACKGROUND
The role of pre-transplant salvage chemotherapy has been controversial in relapsed acute leukemia.


METHODS
We investigated post-transplant outcomes in 65 patients with acute leukemia treated with allogeneic hematopoietic cell transplantation (HCT) during first relapse or second remission.


RESULTS
The 5-year cumulative incidence of relapse (CIR) was 52.3%. Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P = 0.031 and P = 0.031, respectively). Allogeneic HCT was performed in 14 patients after first relapse without salvage chemotherapy ("untreated relapse" group), 15 patients failed chemotherapy for reinduction of remission before HCT ("refractory relapse" group), and 36 patients attained second remission with salvage chemotherapy before HCT ("second remission" group). The 5-year CIR for patients in the untreated relapse group (57.1%) was higher than that for those in the second remission group (42.3%), but it was lower than that for patients in the refractory relapse group (66.7%). Among patients who underwent allogeneic HCT in relapse, those with bone marrow (BM) blasts ≤30% had a lower 5-year CIR than those in florid relapse (BM blasts >30%) (57.7% vs. 70.6%).


CONCLUSIONS
Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse. Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Je-Hwan
JH
Lee
Sung-Soo
SS
Yoon
Chul Won
CW
Jung
Jung-Hee
JH
Lee
Dae-Young
DY
Kim
Young-Shin
YS
Lee
Sung Cheol
SC
Yun
Inho
I
Kim
Seonyang
S
Park
Byoung Kook
BK
Kim
Kihyun
K
Kim
Jin Seok
JS
Ahn
Kyoo-Hyung
KH
Lee