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Acute Leukemia

Clinical outcomes of AML patients relapsing after matched-related donor and umbilical cord blood transplantation

Bone Marrow Transplantation volume 49, pages 1029–1035 (2014)Cite this article

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Abstract

AML relapse remains the leading cause of transplant failure among Allo-SCT recipients. A single institution study was conducted on 348 patients with AML who received an Allo-SCT from an umbilical cord blood (UCB, 222) or HLA-matched-related (RD, 126) donor between 2000–2011. Relapse after Allo-SCT occurred in 72 UCB and 32 RD transplant recipients. Three patients achieved CR after withdrawal of immune suppression with no further therapy. Fifty-two patients received intensive post-relapse therapy, defined as systemic chemotherapy (22 UCB, 7 RD), second Allo-SCT (nine UCB, two RD), or DLI±systemic chemotherapy (0 UCB, 12 RD); of these, 25% achieved CR (21% UCB vs 35% RD, P=0.16). Survival at 1 year after relapse was 22% for all patients (19% UCB vs 28% RD, P=0.36). In multivariable analysis, post-relapse mortality was lower in patients receiving intensive therapy for relapse (hazard ratio (HR)=0.4; 95% confidence interval (CI) 0.2–0.6, P<0.01) and higher in patients with peripheral blood blasts above the median (HR=3.8; 95% CI 2.2–6.6, P<0.01), active infection (HR=1.9; 95% CI 1.0–3.5, P=0.05) and non-infectious medical complications (HR=2.0; 95% CI 1.2–3.5, P=0.01). In conclusion, patients with AML relapsing after Allo-SCT who were in good-enough clinical condition to receive intensive therapy had superior short-term survival.

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Acknowledgements

We would like to acknowledge Michael Franklin, MS, for assistance in editing this manuscript.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA

    N Bejanyan, B Oran, E Warlick, C Ustun, G Vercellotti, D Weisdorf & C Brunstein

  2. Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    R Shanley

  3. Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    M Verneris & J E Wagner

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  1. N Bejanyan
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Correspondence to N Bejanyan.

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Bejanyan, N., Oran, B., Shanley, R. et al. Clinical outcomes of AML patients relapsing after matched-related donor and umbilical cord blood transplantation. Bone Marrow Transplant 49, 1029–1035 (2014). https://doi.org/10.1038/bmt.2014.116

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