title: Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the center for international blood and marrow transplantation research.
abstract: The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed.
authors: Mayo Clinic Florida, Jacksonville, FL, USA.
authors: James M
authors: JM
authors: Foran
authors: Steven Z
authors: SZ
authors: Pavletic
authors: Brent R
authors: BR
authors: Logan
authors: Manza A
authors: MA
authors: Agovi-Johnson
authors: Waleska S
authors: WS
authors: Pérez
authors: Brian J
authors: BJ
authors: Bolwell
authors: Martin
authors: M
authors: Bornhäuser
authors: Christopher N
authors: CN
authors: Bredeson
authors: Mitchell S
authors: MS
authors: Cairo
authors: Bruce M
authors: BM
authors: Camitta
authors: Edward A
authors: EA
authors: Copelan
authors: Jason
authors: J
authors: Dehn
authors: Robert P
authors: RP
authors: Gale
authors: Biju
authors: B
authors: George
authors: Vikas
authors: V
authors: Gupta
authors: Gregory A
authors: GA
authors: Hale
authors: Hillard M
authors: HM
authors: Lazarus
authors: Mark R
authors: MR
authors: Litzow
authors: Dipnarine
authors: D
authors: Maharaj
authors: David I
authors: DI
authors: Marks
authors: Rodrigo
authors: R
authors: Martino
authors: Richard T
authors: RT
authors: Maziarz
authors: Jacob M
authors: JM
authors: Rowe
authors: Philip A
authors: PA
authors: Rowlings
authors: Bipin N
authors: BN
authors: Savani
authors: Mary Lynn
authors: ML
authors: Savoie
authors: Jeffrey
authors: J
authors: Szer
authors: Edmund K
authors: EK
authors: Waller
authors: Peter H
authors: PH
authors: Wiernik
authors: Daniel J
authors: DJ
authors: Weisdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007391:International Cooperation; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D000970:Antineoplastic Agents
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