TY - JOUR
T1 - Outcomes of Adults with Acute Lymphoblastic Leukemia Relapsing after Allogeneic Hematopoietic Stem Cell Transplantation
AU - Poon, Li Mei
AU - Hamdi, Amir
AU - Saliba, Rima
AU - Rondon, Gabriela
AU - Ledesma, Celina
AU - Kendrick, Monique
AU - Qazilbash, Muzaffar
AU - Hosing, Chitra
AU - Jones, Roy B.
AU - Popat, Uday R.
AU - Nieto, Yago
AU - Alousi, Amin
AU - Ciurea, Stefan
AU - Shpall, Elizabeth J.
AU - Champlin, Richard E.
AU - Kebriaei, Partow
PY - 2013/7
Y1 - 2013/7
N2 - For patients with acute lymphoblastic leukemia (ALL) who relapse after allogeneic hematopoietic stem cell transplantation (HSCT), treatment options are limited, and the clinical course and prognostic factors affecting outcome have not been well characterized. We retrospectively analyzed outcomes of 123 adult patients with ALL who relapsed after a first HSCT performed at our center between 1993 and 2011. First-line salvage included second HSCT (n= 19), donor lymphocyte infusion with or without prior chemotherapy (n= 11), radiation therapy (n= 6), cytoreductive chemotherapy (n= 30), mild chemotherapy (n= 27), or palliative care (n= 23), with median postrelapse overall survival (OS) of 10 months, 6.5 months, 3 months, 4 months, 4months, and 1 month, respectively. Despite a complete remission rate of 38% after first-line salvage in the treated patients, the OS rate remained limited with 1- and 2- year OS rates of 17% (95% confidence interval, 13 to 29) and 10% (95% confidence interval, 6 to 20), respectively. On univariate analysis, adverse factors for OS included active disease at the time of first HSCT and short time to progression from first HSCT (<6 months). There was no difference in the 6-month survival postrelapse in patients with isolated extramedullary relapse (44%) compared with combined extramedullary and bone marrow relapse (29%) or those with isolated bone marrow relapse (34%) (P= 8). Our data provide more insight into the disease behavior and treatment outcomes of ALL at relapse after HSCT against which future trials may be compared.
AB - For patients with acute lymphoblastic leukemia (ALL) who relapse after allogeneic hematopoietic stem cell transplantation (HSCT), treatment options are limited, and the clinical course and prognostic factors affecting outcome have not been well characterized. We retrospectively analyzed outcomes of 123 adult patients with ALL who relapsed after a first HSCT performed at our center between 1993 and 2011. First-line salvage included second HSCT (n= 19), donor lymphocyte infusion with or without prior chemotherapy (n= 11), radiation therapy (n= 6), cytoreductive chemotherapy (n= 30), mild chemotherapy (n= 27), or palliative care (n= 23), with median postrelapse overall survival (OS) of 10 months, 6.5 months, 3 months, 4 months, 4months, and 1 month, respectively. Despite a complete remission rate of 38% after first-line salvage in the treated patients, the OS rate remained limited with 1- and 2- year OS rates of 17% (95% confidence interval, 13 to 29) and 10% (95% confidence interval, 6 to 20), respectively. On univariate analysis, adverse factors for OS included active disease at the time of first HSCT and short time to progression from first HSCT (<6 months). There was no difference in the 6-month survival postrelapse in patients with isolated extramedullary relapse (44%) compared with combined extramedullary and bone marrow relapse (29%) or those with isolated bone marrow relapse (34%) (P= 8). Our data provide more insight into the disease behavior and treatment outcomes of ALL at relapse after HSCT against which future trials may be compared.
KW - Acute lymphoblastic leukemia
KW - Allogeneic transplantation
KW - Relapse
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U2 - 10.1016/j.bbmt.2013.04.014
DO - 10.1016/j.bbmt.2013.04.014
M3 - Article
C2 - 23644077
AN - SCOPUS:84879350571
SN - 1083-8791
VL - 19
SP - 1059
EP - 1064
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 7
ER -