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. 2022 Feb;57(2):224-231.
doi: 10.1038/s41409-021-01521-5. Epub 2021 Nov 13.

Feasibility and efficacy of salvage allogeneic stem cell transplantation in AML patients relapsing after autologous stem cell transplantation

Evgenii Shumilov #  1   2 , Inna Shakhanova #  1   3 , Johanna Flach  4 , Nicole Schmidt  1   2 , Susanne Buerki  1 , Myriam Legros  5 , Marie-Noëlle Kronig  1 , Yishai Ofran  6   7 , Sabine Gerull  8 , Michael Medinger  8 , Behrouz Mansouri Taleghani  4 , Jakob Passweg  8 , Jörg Halter  8 , Ulrike Bacher  9 , Thomas Pabst  10
Affiliations

Feasibility and efficacy of salvage allogeneic stem cell transplantation in AML patients relapsing after autologous stem cell transplantation

Evgenii Shumilov et al. Bone Marrow Transplant. 2022 Feb.

Abstract

Autologous hematopoietic cell transplantation (HCT) is suitable for consolidation of favorable-/intermediate-risk AML patients in CR1. However, ~50% of AML patients relapse after autologous HCT, and efficacy of subsequent salvage strategies including allogeneic HCT remains unclear. We studied 123 consecutive patients with newly diagnosed AML undergoing high-dose chemotherapy (HDCT)/autologous HCT in CR1. In relapsing patients afterwards, we analyzed salvage treatments and outcomes focusing particularly on salvage allogeneic HCT. Of 123 patients, 64 (52%) relapsed after autologous HCT. Subsequently, 13 (21%) received palliative therapy, whereas 51 (79%) proceeded to salvage therapy with a curative intent. Of the 47 patients with a curative intent and who did not proceed directly to allogeneic HCT, 23 (49%) achieved CR2 or had ongoing hematologic CR1 despite molecular relapse. Finally, 30 patients (47%) received allogeneic HCT with estimated 3-year leukemia-free and overall survival rates of 33% and 43%. Hematologic remission at allogeneic HCT and lack of acute GvHD had a positive impact on OS and LFS (p < 0.05). Our study suggests that almost 80% of AML patients can undergo salvage therapy following relapse after front-line HDCT/autologous HCT. Allogeneic HCT can provide cure in one third of patients relapsing after front-line HDCT/autologous HCT.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Consort diagram with number of patients undergoing HDCT/autologous HCT in CR1, remission status post autologous HCT, and treatment intentions following relapse post autologous HCT.
HDCT high-dose chemotherapy, HCT hematopoietic cell transplantation, CR1 first complete remission.
Fig. 2
Fig. 2. Outcomes of salvage allogeneic HCT and non-allogeneic HCT treatment in AML patients following relapse after front-line autologous HCT.
a Cumulative incidence of relapse and non-relapse mortality in the salvage allogeneic HCT group following front-line autologous HCT. b Overall survival in the salvage allogeneic HCT group following relapse after front-line autologous HCT. c Leukemia-free survival in the salvage allogeneic HCT group following relapse after front-line autologous HCT. d Overall survival in the non-allogeneic HCT group following relapse after front-line autologous HCT.
See this image and copyright information in PMC

References

    1. Garcia-Manero G, Othus M, Pagel JM, Radich JP, Fang M, Rizzieri DA, et al. SWOG S1203: a randomized phase III study of standard cytarabine plus daunorubicin (7+3) therapy versus idarubicin with high dose cytarabine (IA) with or without vorinostat (IA+V) in younger patients with previously untreated acute myeloid leukemia (AML) Blood. 2016;128:901. doi: 10.1182/blood.V128.22.901.901. - DOI
    1. Walter RB, Othus M, Burnett AK, Löwenberg B, Kantarjian HM, Ossenkoppele GJ, et al. Resistance prediction in AML: analysis of 4601 patients from MRC/NCRI, HOVON/SAKK, SWOG and MD Anderson Cancer Center. Leukemia. 2015;29:312–20. doi: 10.1038/leu.2014.242. - DOI - PMC - PubMed
    1. Poiré X, Labopin M, Polge E, Blaise D, Chevallier P, Maertens J, et al. Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission. Am J Hematol. 2019;94:231–9. - PubMed
    1. Beyar-Katz O, Lavi N, Ringelstein-Harlev S, Henig I, Yehudai-Ofir D, Haddad N, et al. Superior outcome of patients with favorable-risk acute myeloid leukemia using consolidation with autologous stem cell transplantation. Leuk Lymphoma. 2019;60:2449–56. doi: 10.1080/10428194.2019.1594214. - DOI - PubMed
    1. Limvorapitak W, Barnett MJ, Hogge DE, Forrest DL, Nevill TJ, Narayanan S, et al. Outcomes of intermediate risk karyotype acute myeloid leukemia in first remission undergoing autologous stem cell transplantation compared with allogeneic stem cell transplantation and chemotherapy consolidation: a retrospective, propensity-score adjusted analysis. Clin Lymphoma Myeloma Leuk. 2018;18:e481–e491. doi: 10.1016/j.clml.2018.07.290. - DOI - PubMed

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