Late Relapse after Allogeneic Stem Cell Transplantation in Patients Treated for Acute Myeloid Leukemia: Relapse Incidence, Characteristics, Role of Conditioning Regimen, and Outcome
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Patient Selection
2.2. Treatment Characteristics
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Outcome and Factors Affecting Survival, Relapse, and TRM
3.3. Factors Associated with Late Relapse
3.4. Survival of Patients beyond 2 Years from Transplantation
3.5. Treatment of Late AML Relapse
3.6. Cytogenetic Characteristics at Late Relapse
3.7. Chimerism at Relapse
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n = 376 | % | |
---|---|---|
Gender | ||
Male | 194 | 51.6% |
Female | 182 | 48.4% |
Median age (range) | 48.8 y (18.4–71.0) | |
ELN classification | ||
Favorable | 41 | 10.9% |
Intermediate | 159 | 42.3% |
Unfavorable | 105 | 27.9% |
NA | 71 | 18.9% |
Status at grafting | ||
CR | 304 | 80.9% |
Refractory | 72 | 19.1% |
Type of donor | ||
Identical sibling | 177 | 47.1% |
Matched unrelated | 124 | 33% |
Haplo-identical | 16 | 4.3% |
Mismatched unrelated 9/10 | 23 | 6.1% |
Cord blood | 36 | 9.6% |
Type of graft | ||
PBSC | 244 | 64.9% |
BM | 96 | 25.5% |
CB | 36 | 9.6% |
Conditioning | ||
MAC | 120 | 31.9% |
RIC | 209 | 55.6% |
SEQ | 47 | 12.5% |
Year of transplantation | ||
Before 2005 | 113 | 30.1% |
After 2005 | 263 | 69.9% |
Characteristics | Variable (Percentage) | HR (Univariate) | HR (Multivariate) |
---|---|---|---|
Median age at transplant | 48.8 years (18.3–71.0) | 1.01 (1.00–1.02, p = 0.26) | - |
Gender | |||
Male | 194 (51.6%) | - | - |
Female | 182 (48.4%) | 0.68 (0.51–0.90, p = 0.008) | 0.89 (0.65–1.23, p = 0.48) |
ELN 2017 subgroup | |||
Favorable | 41 (10.9%) | - | - |
Intermediate | 159 (42.3%) | 1.26 (0.73–2.16, p = 0.40) | 1.14 (0.66–1.95, p = 0.65) |
Adverse | 105 (27.9%) | 2.06 (1.20–3.55, p = 0.009) | 1.50 (0.85–2.64, p = 0.16) |
Status at transplant | |||
CR | 304 (80.9%) | - | - |
Refractory | 72 (19.1%) | 3.67 (2.71–4.99, p < 0.001) | 3.75 (1.95–7.22, p < 0.001) |
Conditioning | |||
RIC | 209 (55.6%) | - | - |
MAC | 120 (31.9%) | 1.00 (0.72–1.38, p = 0.99) | 0.82 (0.53–1.26, p = 0.36) |
Sequential | 47 (12.5%) | 2.80 (1.93–4.06, p < 0.001 | 0.73 (0.37–1.46, p = 0.37) |
Type of graft | |||
PBSC | 244 (64.9%) | - | - |
BM | 96 (25.5%) | 0.87 (0.62–1.22, p = 0.43) | - |
CB | 36 (9.6%) | 1.06 (0.67–1.68, p = 0.81) | - |
Type de donor | |||
MSD | 177 (47.1%) | - | - |
MUD | 124 (33%) | 1.15 (0.84–1.58, p = 0.39) | - |
Haplo | 16 (4.3%) | 1.49 (0.75–2.97, p = 0.25) | - |
9/10 | 23 (6.1%) | 1.26 (0.71–2.27, p = 0.43) | - |
CB | 36 (9.6%) | 1.20 (0.74–1.93, p = 0.46) | - |
Characteristics | Variable (Percentage) | HR (Univariate) | HR (Multivariate) |
---|---|---|---|
Median age at transplant | 48.8 years (18.3–71.0) | 1.01 (1.00–1.02, p = 0.22) | - |
Gender | |||
Male | 194 (51.6%) | - | - |
Female | 182 (48.4%) | 0.70 (0.53–0.92, p = 0.01) | 0.90 (0.66–1.23, p = 0.52) |
ELN 2017 subgroup | |||
Favorable | 41 (10.9%) | - | - |
Intermediate | 159 (42.3%) | 1.29 (0.75–2.20, p = 0.35)) | 1.17 (0.68–2.00, p = 0.58)) |
Adverse | 105 (27.9%) | 2.24 (1.30–3.85, p = 0.004) | 1.66 (0.95–2.91, p = 0.08) |
Status at transplant | |||
CR | 304 (80.9%) | - | - |
Refractory | 72 (19.1%) | 3.66 (2.70–4.94, p < 0.001) | 3.06 (1.59–5.89, p = 0.001) |
Conditioning | |||
RIC | 209 (55.6%) | - | - |
MAC | 120 (31.9%) | 0.90 (0.65–1.23, p = 0.51) | 0.83 (0.54–1.26, p = 0.37) |
Sequential | 47 (12.5%) | 2.95 (2.04–4.26, p < 0.001) | 0.90 (0.45–1.80, p = 0.76) |
Type of graft | |||
PBSC | 244 (64.9%) | - | - |
BM | 96 (25.5%) | 0.80 (0.58–1.11, p = 0.19) | - |
CB | 36 (9.6%) | 1.11 (0.71–1.74, p = 0.65) | - |
Type de donor | |||
MSD | 177 (47.1%) | - | - |
MUD | 124 (33%) | 1.17 (0.86–1.60, p = 0.32) | - |
Haplo | 16 (4.3%) | 1.34 (0.68–2.67, p = 0.40) | - |
9/10 | 23 (6.1%) | 1.43 (0.83–2.47, p = 0.20) | - |
CB | 36 (9.6%) | 1.30 (0.82–2.08, p = 0.26) | - |
Period of Time Post-Transplant | Relapses N = 142 (37.7%) | Patients Alive without Relapse at the End of Each Post-Transplant Year |
---|---|---|
First year (months 0 to 12) | 97 relapses/376 (26%) | 222 |
Second year (months 13 to 24) | 19 relapses/221 (8.1%) | 199 |
Third year (months 25 to 36) | 13 relapses/198 (7%) | 179 |
Fourth year (months 37–48) | 4 relapses/179 (2.2%) | 170 |
Fifth year (months 49–60) | 2 relapses/170 (1.7%) | 147 |
Sixth year (months 61–72) | 1 relapses/146 (1.3%) | * |
Seventh year (months 73–84) | 1 relapse/ | * |
Eighth year (months 85–96) | no relapse/ | * |
Ninth year (months 97–108) | 3 relapses/ | * |
Tenth year (months 108–120) | 2 relapses/ | * |
Characteristics | Late Relapse (n = 26) | No Relapse (n = 170) | p-Value (Chi2 or t-Test) |
---|---|---|---|
Median age at transplant | 53.9 | 47.7 | 0.046 |
Sex | |||
Male | 9 (34.6%) | 79 (45.7%) | 0.398 |
Female | 17 (65.4%) | 94 (54.3%) | |
ELN 2017 subgroup | |||
Favorable | 2 (7.7%) | 25 (14.5%) | 0.265 |
Intermediate | 10 (38.5%) | 81 (46.8%) | |
Adverse | 9 (34.6%) | 32 (18.5%) | |
NA | 5 (19.2%) | 35 (20.2%) | |
Status at transplant | |||
CR | 22 (84.6%) | 163 (94.2%) | 0.169 |
Active disease | 4 (15.4%) | 10 (5.8%) | |
Conditioning | |||
RIC | 16 (61.5%) | 103 (59.5%) | 0.739 |
MAC | 8 (30.8%) | 62 (35.8%) | |
Sequential | 2 (7.7%) | 8 (4.6%) | |
Graft source | |||
PBSC | 17 (65.4%) | 108 (62.4%) | 0.827 |
BM | 6 (23.1%) | 49 (28.3%) | |
CB | 3 (11.5%) | 16 (9.2%) | |
Type of donor | |||
MSD | 11 (42.3%) | 86 (49.7%) | 0.516 |
MUD | 9 (34.6%) | 57 (32.9%) | |
Haplo | 0 (0%) | 6 (3.5%) | |
09/10 | 3 (11.5%) | 8 (4.6%) | |
Cord blood | 3 (11.5%) | 16 (9.2%) | |
Acute GVHD | |||
No | 11 (42.3%) | 85 (49.1%) | 0.801 |
Grade 1–2 | 12 (46.2%) | 69 (39.9%) | |
Grade 3–4 | 3 (11.5%) | 19 (11%) | |
Chronic GVHD | |||
None | 25 (96.2%) | 129 (74.6%) | 0.028 |
Extensive | 1 (3.8%) | 44 (25.4%) |
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Antier, C.; Jullien, M.; Tessoulin, B.; Loirat, M.; Peterlin, P.; Garnier, A.; Le Bourgeois, A.; Chevallier, P.; Guillaume, T. Late Relapse after Allogeneic Stem Cell Transplantation in Patients Treated for Acute Myeloid Leukemia: Relapse Incidence, Characteristics, Role of Conditioning Regimen, and Outcome. Cancers 2024, 16, 1419. https://doi.org/10.3390/cancers16071419
Antier C, Jullien M, Tessoulin B, Loirat M, Peterlin P, Garnier A, Le Bourgeois A, Chevallier P, Guillaume T. Late Relapse after Allogeneic Stem Cell Transplantation in Patients Treated for Acute Myeloid Leukemia: Relapse Incidence, Characteristics, Role of Conditioning Regimen, and Outcome. Cancers. 2024; 16(7):1419. https://doi.org/10.3390/cancers16071419
Chicago/Turabian StyleAntier, Chloé, Maxime Jullien, Benoît Tessoulin, Marion Loirat, Pierre Peterlin, Alice Garnier, Amandine Le Bourgeois, Patrice Chevallier, and Thierry Guillaume. 2024. "Late Relapse after Allogeneic Stem Cell Transplantation in Patients Treated for Acute Myeloid Leukemia: Relapse Incidence, Characteristics, Role of Conditioning Regimen, and Outcome" Cancers 16, no. 7: 1419. https://doi.org/10.3390/cancers16071419
APA StyleAntier, C., Jullien, M., Tessoulin, B., Loirat, M., Peterlin, P., Garnier, A., Le Bourgeois, A., Chevallier, P., & Guillaume, T. (2024). Late Relapse after Allogeneic Stem Cell Transplantation in Patients Treated for Acute Myeloid Leukemia: Relapse Incidence, Characteristics, Role of Conditioning Regimen, and Outcome. Cancers, 16(7), 1419. https://doi.org/10.3390/cancers16071419