title: Treatment, risk factors, and outcome of adults with relapsed AML after reduced intensity conditioning for allogeneic stem cell transplantation.
abstract: Because information on management and outcome of AML relapse after allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of EBMT. Among 2815 RIC transplants performed for AML in complete remission (CR) between 1999 and 2008, cumulative incidence of relapse was 32% ± 1%. Relapsed patients (263) were included into a detailed analysis of risk factors for overall survival (OS) and building of a prognostic score. CR was reinduced in 32%; remission duration after transplantation was the only prognostic factor for response (P = .003). Estimated 2-year OS from relapse was 14%, thereby resembling results of AML relapse after standard conditioning. Among variables available at the time of relapse, remission after HSCT > 5 months (hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.37-0.67, P < .001), bone marrow blasts less than 27% (HR = 0.53, 95% CI, 0.40-0.72, P < .001), and absence of acute GVHD after HSCT (HR = 0.67, 95% CI, 0.49-0.93, P = .017) were associated with better OS. Based on these factors, 3 prognostic groups could be discriminated, showing OS of 32% ± 7%, 19% ± 4%, and 4% ± 2% at 2 years (P < .0001). Long-term survival was achieved almost exclusively after successful induction of CR by cytoreductive therapy, followed either by donor lymphocyte infusion or second HSCT for consolidation.
authors.affiliation: Klinikum Augsburg, University of Munich, Munich, Germany. christoph.schmid@klinikum-augsburg.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.forename: Michael
authors.initials: M
authors.lastname: Stadler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kuball
authors.forename: Jan
authors.initials: J
authors.lastname: Cornelissen
authors.forename: Jiri
authors.initials: J
authors.lastname: Vorlicek
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
authors.forename: Lars
authors.initials: L
authors.lastname: Vindeløv
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Andreas
authors.initials: A
authors.lastname: Rank
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Polge
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005060:Europe; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult