Extramedullary Relapse of Acute Myelogenous Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

The clinical significance of extramedullary relapse (EMR) of acute myelogenous leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains poorly defined. Here we report the clinical outcomes of patients who underwent allo-HSCT for AML at our institution between 2000 and 2012. A total of 293 patients with AML who underwent allo-HSCT were included. The median duration of follow-up in survivors was 1840 days. Disease status at the time of allo-HSCT was complete remission in 192 patients and nonremission in 101 patients. A total of 110 patients experienced AML relapse after allo-HSCT, including 18 with EMR only, 83 with bone marrow relapse (BMR) only, and 9 with both EMR and BMR. The 5-year cumulative incidence of EMR after allo-HSCT was 9.5%, whereas that of BMR only was 28.9%. In multivariate analysis, peripheral blood stem cell transplantation was associated with an increased risk of EMR. The 2-year overall survival after post-transplantation relapse was 7.5% in patients with BMR only, 11.1% in those with both EMR and BMR, and 27.5% in those with EMR only (P < .05). Although the short-term survival was better in patients with EMR only, they rarely achieved long-term survival. Appropriate strategies for both post-transplantation EMR and BMR are needed.

Acute myeloid leukemia relapse after allogeneic hematopoietic stem cell transplantation: a retrospective study from a single institution

“…The current study showed a relapse rate of 31.0% (26/84) in a real-life setting. This was similar to the relapse rate reported by Yuda et al., 14 who found an estimated relapse rate of 37.5% in this patient group. Furthermore, Yuda et al.…”

Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity

“… No. Age at disease onset [years] Sex [m/f] Diagnosis Cyto-/ Molecular Genetics/ELN risk category [ 20 ] Monoblastic morphology Conditioning intensity [ 14 – 19 ] Donor source HCT-CI [ 50 ] Severity of acute GvHD [ 22 ] Severity of chronic GvHD [ 23 ] Isolated extra-medullary MS Chimerism at time of MS [%] MSFS [days] OS MS [days] Site of relapse [ 7 , 33 , 34 ] Therapy for MS [antitumoral drugs, radiation, DLI] 1 a,b 59 f AML Complex aberrant/adverse No RIC (bu, flu) [ 14 ] MUD 2 I (skin II and liver I) Mild No (systemic relapse within 30 months) 100 1,021 4,052 Skin, breast [ 51 ], stomach, small intestine, right auricle, frontal sinus, intraspinally along spinal cord, carcinomatous meningitis Intrathecal triple [ 32 ], LDAC [ 31 ]; radiation; DLI 2 55 f AML 46,XX/FLT3-LM high , NPM1/intermediate No RIC (treo, flu) [ 15 ] MMUD (C antigen) 5 III (intestinal III) None No (systemic relapse within 4 months) 79 134 234 Within brain mass [ 52 ], carcinomatous meningitis Intrathecal triple [ 32 ], azacytidine [ 26 ] 3 b 57 f …”

“…Although the armamentarium for the treatment of isolated MS has been widened since the introduction of targeted therapies, one should keep in mind that MS represents part of a systemic disease and is believed to progress rapidly to systemic relapse without therapy [ 9 , 11 ]. Therefore, systemic chemotherapy may be an appropriate therapeutic approach [ 34 , 46 ]. Nevertheless, the optimal therapy post-HSCT is a matter of debate.…”

“…Isolated EM relapse after HSCT is a rare event, with incidence rates between 0.65-30% [13,[33][34][35][36] and a median MSFS of 210 days [6,34]. Three-fourths of EM relapses happened within the first 2 years after HSCT [7].…”

Extramedullary acute myeloid leukemia (eAML): Retrospective single center cohort study on clinico-pathological, molecular analysis and survival outcomes

“…The rates of eAML with or without marrow involvement at diagnosis ranged between 0.2 to 2.8% and 0.6–0.8% and, reached 8% on autopsy studies among patients dying from AML [ 2 , 6 , 7 ]. Following allotransplant, the incidence has been reported to be 16–24% in total [ [8] , [9] , [10] ], 8–18% isolated and 2–8% with marrow involvement; which accounts for 7–46% of post-transplant relapses. eAML may occur in every organ, but most commonly involved sites are soft tissue/connective tissue (31–35%) and skin (11–46%), gastrointestinal system (10–19%).…”