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Relapse of acute myeloid leukemia after allogeneic hematopoietic cell transplantation: clinical features and outcomes

Bone Marrow Transplantation volume 56, pages 1126–1133 (2021)Cite this article

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Abstract

Posttransplant relapse represents the greatest obstacle to the success of allogeneic hematopoietic cell transplantation (HCT) for patients with acute myeloid leukemia (AML). This study investigated clinical features and outcomes of posttransplant relapse of AML based on data for 1265 patients with AML suffering relapse after allogeneic HCT conducted during complete remission (CR). Relapse occurred at a median of 6.1 months. The incidence rate of relapse peaked at 29.0 per 100 patient-years during the first 3–6 months period post transplant, after which the rate declined over time, and after 3 years remained consistently at less than 1 per 100 patient-years. The probability of overall survival (OS) after posttransplant relapse was 19% at 2 years, with 68% of deaths being attributed to leukemia. The interval from transplantation to relapse was identified as the strongest indicator for OS. Donor lymphocyte infusion (DLI) and second allogeneic HCT (HCT2) were administered to 152 (12%) and 481 (38%) patients, respectively. Landmark analyses showed some signs of survival benefit when these procedures were performed during CR, but no benefit was gained when performed during non-CR. Our findings clarify clinical features of posttransplant relapse of AML, and indicate the urgent need for developing effective bridging to cellular therapies.

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Fig. 1: Changes in the incidence rates of relapse and non-relapse mortality after allogeneic HCT.
Fig. 2: Overall survival from posttransplant relapse according to the interval from transplantation to relapse.
Fig. 3: Landmark analysis of overall survival for patients who did or did not undergo donor lymphocyte infusion (DLI) before the landmark period.
Fig. 4: Landmark analysis of overall survival for patients who did or did not undergo second allogeneic hematopoietic cell transplantation (HCT2) before the landmark period.

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Acknowledgements

This work was supported in part by a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED), grant number: 18ek0510023h0002, and a grant from the Aichi Cancer Research Foundation, grant number: 2020-1-11.

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Authors and Affiliations

  1. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

  2. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

  3. National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan

    Satoshi Yamasaki

  4. Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tadakazu Kondo

  5. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  6. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Naoki Shingai

  7. Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  8. Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  9. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  10. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  11. Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hirohisa Nakamae

  12. Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  13. Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  14. Japanese Red Cross Kinki Block Blood Center, Osaka, Japan

    Takafumi Kimura

  15. Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  16. Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  18. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  19. The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

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  1. Masamitsu Yanada
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Correspondence to Masamitsu Yanada.

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Yanada, M., Konuma, T., Yamasaki, S. et al. Relapse of acute myeloid leukemia after allogeneic hematopoietic cell transplantation: clinical features and outcomes. Bone Marrow Transplant 56, 1126–1133 (2021). https://doi.org/10.1038/s41409-020-01163-z

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