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. 2024 May 2;14(1):76.
doi: 10.1038/s41408-024-01060-4.

Continuously improving outcome over time after second allogeneic stem cell transplantation in relapsed acute myeloid leukemia: an EBMT registry analysis of 1540 patients

Ann-Kristin Schmälter  1 , Maud Ngoya  2 , Jacques-Emmanuel Galimard  2 , Ali Bazarbachi  3 , Jürgen Finke  4 , Nicolaus Kröger  5 , Martin Bornhäuser  6 , Matthias Stelljes  7 , Friedrich Stölzel  8 , Johanna Tischer  9 , Thomas Schroeder  10 , Peter Dreger  11 , Igor-Wolfgang Blau  12 , Bipin Savani  13 , Sebastian Giebel  14 , Jordi Esteve  15 , Arnon Nagler  16 , Christoph Schmid  17 , Fabio Ciceri #  18 , Mohamad Mohty #  2
Affiliations

Continuously improving outcome over time after second allogeneic stem cell transplantation in relapsed acute myeloid leukemia: an EBMT registry analysis of 1540 patients

Ann-Kristin Schmälter et al. Blood Cancer J. .

Abstract

Second allogeneic stem cell transplantation (alloSCT2) is among the most effective treatments for acute myeloid leukemia (AML) relapse after first alloSCT (alloSCT1). Long-term EBMT registry data were used to provide large scale, up-to-date outcome results and to identify factors for improved outcome. Among 1540 recipients of alloSCT2, increasing age, better disease control and performance status before alloSCT2, more use of alternative donors and higher conditioning intensity represented important trends over time. Between the first (2000-2004) and last (2015-2019) period, two-year overall and leukemia-free survival (OS/LFS) increased considerably (OS: 22.5-35%, LFS: 14.5-24.5%). Cumulative relapse incidence (RI) decreased from 64% to 50.7%, whereas graft-versus-host disease and non-relapse mortality (NRM) remained unchanged. In multivariable analysis, later period of alloSCT2 was associated with improved OS/LFS (HR = 0.47/0.53) and reduced RI (HR = 0.44). Beyond, remission duration, disease stage and patient performance score were factors for OS, LFS, RI, and NRM. Myeloablative conditioning for alloSCT2 decreased RI without increasing NRM, leading to improved OS/LFS. Haploidentical or unrelated donors and older age were associated with higher NRM and inferior OS. In summary, outcome after alloSCT2 has continuously improved over the last two decades despite increasing patient age. The identified factors provide clues for the optimized implementation of alloSCT2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Outcomes over time after second allogeneic stem cell transplantation.
Overall survival, leukemia-free survival, non-relapse mortality, the cumulative incidence of relapse and graft-versus-host disease/ relapse-free survival after second allogeneic stem cell transplantation for patients transplanted between 2000 and 2004, 2005 and 2009, 2010 and 2014, and 2015 and 2019.
See this image and copyright information in PMC

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