1. ¹Department of Internal Medicine, University of Chicago Hospitals, Chicago, IL, USA
2. ²Department of Internal Medicine, Section of Hematology/Oncology, University of Chicago Hospitals, Chicago, IL, USA
3. ³Department of Health Studies, University of Chicago Hospitals, Chicago, IL, USA

Correspondence: Dr AS Artz, Department of Internal Medicine, Section of Hematology/Oncology, University of Chicago Hospitals, 5841 South Maryland Avenue, MC 2115, Chicago, IL 60637-1470, USA. E-mail: aartz@medicine.bsd.uchicago.edu

Received 27 March 2007; Revised 21 May 2007; Accepted 5 June 2007; Published online 10 September 2007.

Abstract

We describe treatment, outcomes and prognostic factors for patients who relapse following transplantation with a reduced intensity conditioning regimen. Seventy consecutive patients with high-risk myeloid malignancies underwent transplant and 25 (36%) relapsed, a median of 120 days later. The median percentage of bone marrow blasts at relapse was 24, the median donor chimerism was 73% and new karyotypic abnormalities occurred in 8 out of 20 (40%) evaluable patients. Twenty-one patients (84%) received aggressive treatment for relapse, including chemotherapy (60%), second hematopoietic cell transplantation (HCT; 52%) and/or donor lymphocyte infusion (DLI; 12%). Thirteen achieved a complete response (CR) and four remain in CR. Median overall survival (OS) after relapse was 6 months (95% confidence interval=2.7–9.9 months), and actuarial 1 year OS was 24%. Most deaths were due to disease progression (17/20, 85%). We did not observe an advantage for cellular therapy (DLI or second transplant) compared to chemotherapy. Salvage therapy for relapse after reduced intensity HCT is feasible, associated with low treatment-related mortality, and may result in prolonged survival in select patients. Studies exploring the optimal treatment for relapse following reduced intensity HCT are warranted.