Conflict of interest: Nothing to report.
Outcome of 93 patients with relapse or progression following allogeneic hematopoietic cell transplantation†
Version of Record online: 8 OCT 2009
Copyright © 2009 Wiley-Liss, Inc.
American Journal of Hematology
Volume 84, Issue 12, pages 815–820, December 2009
How to Cite
Kurosawa, S., Fukuda, T., Tajima, K., Saito, B., Fuji, S., Yokoyama, H., Kim, S.-W., Mori, S.-I., Tanosaki, R., Heike, Y. and Takaue, Y. (2009), Outcome of 93 patients with relapse or progression following allogeneic hematopoietic cell transplantation. Am. J. Hematol., 84: 815–820. doi: 10.1002/ajh.21555
- Issue online: 23 NOV 2009
- Version of Record online: 8 OCT 2009
- Accepted manuscript online: 8 OCT 2009 12:00AM EST
- Manuscript Accepted: 30 SEP 2009
- Manuscript Revised: 17 SEP 2009
- Manuscript Received: 26 JUN 2009
Relapse/progression after allogeneic hematopoietic cell transplantation (allo-HCT) remains the major cause of treatment failure. In this study, the subsequent clinical outcome was overviewed in 292 patients with leukemia/myelodysplastic syndrome who received allo-HCT. Among them, 93 (32%) showed relapse/progression. Cohort 1 was chosen to receive no interventions with curative intent (n = 25). Cohort 2 received reinduction chemotherapy and/or donor lymphocyte infusion (n = 48), and Cohort 3 underwent a second allo-HCT (n = 20). Sixty-three patients received reinduction chemotherapy, and 27 (43%) achieved subsequent complete remission (CR). The incidence of nonrelapse mortality (NRM) was similar among the three cohorts (4, 15, and 5%). The 1-year overall survival (OS) after relapse was significantly better in patients with a second HCT (58%) than in others (14%, Cohorts 1 and 2; P <.001). However, the 2-year OS did not differ between the two groups, which suggests that it is difficult to maintain CR after the second HCT. Multivariate analysis showed that reinduction chemotherapy, CR after intervention, second HCT, and longer time to post-transplant relapse were associated with improved survival. In conclusion, for patients with relapse after allo-HCT, successful reinduction chemotherapy and a second HCT may be effective for prolonging survival without excessive NRM. However, effective measures to prevent disease progression after a second HCT clearly need to be developed. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc.