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Azacitidine in the treatment of extramedullary relapse of AML after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 48, pages 994–995 (2013)Cite this article

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Extramedullary relapse of AML after allogeneic hematopoietic SCT (HSCT) is rare and less well-defined than systemic disease relapse. In a European Group for Blood and Marrow Transplantation (EBMT) study, the incidence of extramedullary relapse after HSCT was as low as 0.65% in AML.1 However, other studies have reported an incidence of up to 20% among long-term survivors.1, 2, 3, 4, 5, 6 There are no established guidelines for clinical decision making pertaining to the treatment of extramedullary relapse after HSCT.7 Common practice entails a combination of localized radiation, systemic chemotherapy, immunotherapy with donor lymphocyte infusions (DLI), and repeated transplantation if possible. We present in this report our experience in treating two patients with extramedullary non-hematological disease in the setting of relapsed AML previously treated with HSCT, DLI, chemotherapy and radiotherapy.

Extramedullary relapse after HSCT in AML is rare with a median time to diagnosis longer than to BM relapse (about 12–17 months vs 3–6 months, respectively).1, 3, 6 Although the prognosis is poor for extramedullary relapse, it is better than for systemic relapse, with a 2-year OS of 11–38%.1, 3 Therefore, the goal of therapy should be to prevent systemic relapse.

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Author notes

  1. A Antar and Z K Otrock: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    A Antar, Z Salem & A Bazarbachi

  2. Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Z K Otrock

  3. Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA

    M Kharfan-Dabaja

  4. Department of Dermatology, Tenon Hospital, APHP and Paris 6 University, Paris, France

    S Aractingi

  5. Hematologie Clinique, Université de Nantes and INSERM CRNCA UMR892, Nantes, France

    M Mohty

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  1. A Antar
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Correspondence to A Bazarbachi.

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Antar, A., Otrock, Z., Kharfan-Dabaja, M. et al. Azacitidine in the treatment of extramedullary relapse of AML after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 48, 994–995 (2013). https://doi.org/10.1038/bmt.2012.256

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