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Journal of Hematology & Oncology
Published in: Journal of Hematology & Oncology 1/2019

Open Access 01-12-2019 | Acute Myeloid Leukemia | Research

Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT

Authors: Simona Piemontese, Ariane Boumendil, Myriam Labopin, Christoph Schmid, Fabio Ciceri, William Arcese, Yener Koc, Zafar Gulbas, Johanna Tischer, Benedetto Bruno, Depei Wu, Didier Blaise, Dietrich Beelen, Giuseppe Irrera, Annalisa Ruggeri, Mohamed Houhou, Mohamad Mohty, Arnon Nagler, on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Published in: Journal of Hematology & Oncology | Issue 1/2019

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Abstract

Background

As information on incidence, risk factors, and outcome of acute leukemia (AL) relapse after unmanipulated haploidentical stem cell transplantation (haplo-SCT) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.

Methods

Among 1652 transplants performed for lymphoblastic and myeloid AL between 2007 and 2014, 587 patients (acute lymphoblastic leukemia (ALL) 131, acute myeloid leukemia (AML) 456) with detailed information were analyzed aiming to identify risk factors for post-transplant relapse and for overall survival (OS) after relapse.

Results

The cumulative incidence of relapse at 3 years was 44% (35–53%) for ALL and 32% (27–36%) for AML (p = 0.023). In ALL, risk factors for relapse were disease status different from the first complete remission (CR1) at haplo-SCT (CR2 vs CR1: HR 2.85, p = 0.011; advanced vs CR1: HR 14.28, p < 0.0001) and male donor gender (HR 3.64, p = 0.0002), while in AML, risk factors were advanced disease at haplo-SCT (advanced vs CR1: HR 3.95, p < 0.0001) and comorbidities (HCT-CI) ≥ 3 (HR 1.75, p = 0.014). Transplants performed in more recent years were associated with lower relapse incidence (RI) in AML, but not in ALL (HR 0.91, p = 0.042). After relapse, median follow-up was 13 months (mos). OS at 1-year post relapse was 18%. Prognostic factors for superior OS after relapse were remission at time of haplo-SCT (CR vs advanced: HR 0.71, p = 0.028), time from transplant to relapse (≥ 5 mos vs < 5 mos: HR 0.530, p < 0.0001), and bone marrow as a stem cell source (peripheral blood (PB) vs bone marrow (BM): HR 1.473, p = 0.016).

Conclusions

Risk factors for relapse after haploidentical transplantation were disease specific. Longer OS after relapse was achieved in particular by patients both in CR at haplo-SCT and relapsing more than 5 months after transplant (1-year OS 33%).
Appendix
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Metadata
Title
Leukemia relapse following unmanipulated haploidentical transplantation: a risk factor analysis on behalf of the ALWP of the EBMT
Authors
Simona Piemontese
Ariane Boumendil
Myriam Labopin
Christoph Schmid
Fabio Ciceri
William Arcese
Yener Koc
Zafar Gulbas
Johanna Tischer
Benedetto Bruno
Depei Wu
Didier Blaise
Dietrich Beelen
Giuseppe Irrera
Annalisa Ruggeri
Mohamed Houhou
Mohamad Mohty
Arnon Nagler
on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Hematology & Oncology / Issue 1/2019
Electronic ISSN: 1756-8722
DOI
https://doi.org/10.1186/s13045-019-0751-4

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