Relapse after allogeneic bone marrow transplantation for acute leukaemia: a survey by the E.B.M.T. of 117 cases

Abstract

A multi-centre retrospective analysis on 117 patients relapsing after bone marrow transplantation (BMT) for acute leukaemia was carried out by the Leukaemia Working Party of the European Group for Bone Marrow Transplantation (E.B.M.T.). Forty-one patients had acute myeloid leukaemia (AML) and 76 had acute lymphoblastic leukaemia (ALL). Relapse occurred between 3 and 30 months after BMT and where investigated the leukaemia was found to have relapsed in recipient cells. In 10 cases the relapse was associated with new cytogenetic abnormalities. 74 patients received further treatment for leukaemia. Of these 21 out of 50 with ALL and 11 out of 24 with AML achieved a complete remission and had a median survival of 12 months compared with a median survival of 4 months for untreated patients or patients not achieving complete remission (P less than 0.001). Factors predictive for successful remission induction were a long interval between bone marrow transplant and relapse in ALL patients; and isolated extramedullary relapse. Presenting blast count, karyotype and remission status and number at the time of BMT were not predictive. Donor bone marrow was shown to be responsible for haemopoietic recovery occurring in the 21 out of 31 patients tested who achieved remission using donor karyotype or red blood cell antigens as markers. Nine patients received a second bone marrow transplant but only one became a long-term survivor. The results show that chemotherapy can usually prolong survival in selected patients with acute leukaemia relapsing after BMT but further BMT has a poor outlook.

Reduced-intensity conditioning with fludarabine and thiotepa for second allogeneic transplantation of relapsed patients with AML

“…Similar to other reports, a main prognostic factor for OS was the time to relapse after the first allo-SCT with a median OS of 4.8 months after second allo-SCT for patients relapsing at p12 months. 6,22 Supportive care alone confers a median OS of 4 months for relapsed allografted patients, 24 thus our data support the recommendation of a second allograft as a viable option for patients relapsing later than 1 year post transplant. 15 Patient age was another significant prognostic factor and correlated inversely with survival.…”

Double allogeneic hematopoietic SCT as a rescue therapy for poor-risk hematological malignancies

“…Prognostic factors for remission induction were a low-blast count at the time of transplant and a normal karyotype at presentation, number of previous remissions at HSCT, and a long interval between HSCT and relapse. 2,39 In our group of patients with acute leukemia, relapsing after previous allogeneic HSCT, long-term survival was unsatisfactory despite dHSCT. Only two patients were still alive; one patient is in CR 33 months after dHSCT for relapsed AML with an intermediate cytogenetic profile, and with slow disease kinetics.…”

“…In contrast, the median survival of patients with best supportive care and those who did not reach a CR was 4 months. 2 Some case reports suggest occasional long-term survivors after conventional reinduction chemotherapy 39 or second HSCT. 40 Barrett et al analyzed 90 patients receiving second HSCT for relapsed leukemia.…”

“…The patients were divided into two groups: acute or chronic leukemia with poor-risk features but without previous allogeneic HSCT (1), or acute or chronic leukemia with relapse after allogeneic HSCT (2). Poor-risk features in the first group were defined as follows: secondary acute leukemia, relapses of acute leukemia after conventional chemotherapy, primary induction failure (PIF) and chronic myelogenous leukemia (CML) in accelerated phase/blast crisis.…”

“…Responses to conventional reinduction chemotherapy or allogeneic hematopoietic SCT (HSCT) without previous CR are generally poor with low rates and short duration of remissions. [1][2][3] Likewise, the therapeutic options for patients with relapses after allogeneic HSCT are limited. Several approaches have been evaluated, including donor-lymphocyte infusions with or without previous reinduction chemotherapy and direct allogeneic HSCT with myeloablative conditioning or high-dose melphalan.…”