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Prognostic factors and clinical outcomes in patients with relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 58, pages 863–873 (2023)Cite this article

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Abstract

Relapse is a significant barrier to allogeneic hematopoietic stem cell transplantation (allo-HSCT) success. To explore the prognosis of patients who underwent relapse after allo-HSCT, we retrospectively examined 740 consecutive acute leukemia patients in our single center transplanted between January 2013 and December 2018, of which 178 relapsed. The median survival was 204 days (95%CI, 160.7–247.3) from relapse, and the 3-year post-relapse overall survival (prOS) rate was 17.8% (95%CI, 12.5–25.3%). Overall complete remission (CR) or CR with incomplete hematologic recovery (CRi) was achieved in 32.1% for the acute myeloid leukemia and 45.3% for acute lymphoblastic leukemia patients after salvage therapy, respectively. Grade III-IV acute graft-versus-host disease (GVHD) after transplantation and >20% bone marrow blasts at relapse were associated with worse prOS, while patients with chronic GVHD after transplantation, relapse later than 1 year after transplantation, and solitary extramedullary disease had better prOS. Therefore, we developed a concise risk scoring system for prOS based on the number of risk factors affecting prOS. This scoring system was validated with another cohort of post-transplant relapsed acute leukemia patients who received allo-HSCT between 2019 and 2020. Identifying relapse risk factors and providing personalized care for patients with poor prognoses is crucial for improving survival.

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Fig. 1: Flow chart of this research.
Fig. 2: The incidence of relapse-related mortality and prNRM competing risks model.
Fig. 3: Forest plots.
Fig. 4: Post-relapse OS with different treatments.
Fig. 5: Risk grouping of patients with relapse after HSCT.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (grant nos. 82170210).

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Author notes

  1. These author contributed equally: Yang Gao, Hengwei Wu.

Authors and Affiliations

  1. Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Yang Gao, Hengwei Wu, Zhuoyue Shi, Fei Gao, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Huarui Fu, Lizhen Liu, He Huang & Yanmin Zhao

  2. Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China

    Yang Gao, Hengwei Wu, Zhuoyue Shi, Fei Gao, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Huarui Fu, Lizhen Liu, He Huang & Yanmin Zhao

  3. Institute of Hematology, Zhejiang University, Hangzhou, China

    Yang Gao, Hengwei Wu, Zhuoyue Shi, Fei Gao, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Huarui Fu, Lizhen Liu, He Huang & Yanmin Zhao

  4. Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China

    Yang Gao, Hengwei Wu, Zhuoyue Shi, Fei Gao, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Huarui Fu, Lizhen Liu, He Huang & Yanmin Zhao

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Contributions

YG and HW contributed to collecting and analyzing the data and writing the manuscript; ZS and FG reviewed the literature and approved the final draft; JS, YL, JY, XL, HF and LL supported the treatment course of these patients and approved the final draft; HH and YZ are corresponding authors and they critically reviewed the patients and the manuscript.

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Correspondence to He Huang or Yanmin Zhao.

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Gao, Y., Wu, H., Shi, Z. et al. Prognostic factors and clinical outcomes in patients with relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 58, 863–873 (2023). https://doi.org/10.1038/s41409-023-01989-3

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