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Allogeneic hematopoietic cell transplantation for acute leukemia in first relapse or second remission.

Lee JH, Yoon SS, Jung CW, Lee JH, Kim DY, Lee YS, Yun SC, Kim I, Park S, Kim BK, Kim K, Ahn JS, Lee KH - Korean J Hematol (2010)

Bottom Line: Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P = 0.031 and P = 0.031, respectively).Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse.Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background: The role of pre-transplant salvage chemotherapy has been controversial in relapsed acute leukemia.

Methods: We investigated post-transplant outcomes in 65 patients with acute leukemia treated with allogeneic hematopoietic cell transplantation (HCT) during first relapse or second remission.

Results: The 5-year cumulative incidence of relapse (CIR) was 52.3%. Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P = 0.031 and P = 0.031, respectively). Allogeneic HCT was performed in 14 patients after first relapse without salvage chemotherapy ("untreated relapse" group), 15 patients failed chemotherapy for reinduction of remission before HCT ("refractory relapse" group), and 36 patients attained second remission with salvage chemotherapy before HCT ("second remission" group). The 5-year CIR for patients in the untreated relapse group (57.1%) was higher than that for those in the second remission group (42.3%), but it was lower than that for patients in the refractory relapse group (66.7%). Among patients who underwent allogeneic HCT in relapse, those with bone marrow (BM) blasts ≤30% had a lower 5-year CIR than those in florid relapse (BM blasts >30%) (57.7% vs. 70.6%).

Conclusion: Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse. Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.

No MeSH data available.


Related in: MedlinePlus

Cumulative incidences of relapse and non-relapse mortality.
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Figure 2: Cumulative incidences of relapse and non-relapse mortality.

Mentions: A median follow-up for 673 days (range, 151-3,010 days) among surviving patients indicated that 34 had relapsed and 49 had died. We observed 56 events (deaths or relapses). Of the 49 deaths, 22 were not related to leukemia relapse. These 22 non-relapse deaths were caused by infection (N=10), GVHD (N=4), hepatic venoocclusive disease (N=4), bleeding (N=2), thrombotic thrombocytopenic purpura (N=1), and suicide (N=1). The 5-year probabilities of OS and EFS were 20.6% and 14.0%, respectively (Fig. 1), and the 5-year CIR and NRM were 51.3% and 34.7%, respectively (Fig. 2).


Allogeneic hematopoietic cell transplantation for acute leukemia in first relapse or second remission.

Lee JH, Yoon SS, Jung CW, Lee JH, Kim DY, Lee YS, Yun SC, Kim I, Park S, Kim BK, Kim K, Ahn JS, Lee KH - Korean J Hematol (2010)

Cumulative incidences of relapse and non-relapse mortality.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2983023&req=5

Figure 2: Cumulative incidences of relapse and non-relapse mortality.
Mentions: A median follow-up for 673 days (range, 151-3,010 days) among surviving patients indicated that 34 had relapsed and 49 had died. We observed 56 events (deaths or relapses). Of the 49 deaths, 22 were not related to leukemia relapse. These 22 non-relapse deaths were caused by infection (N=10), GVHD (N=4), hepatic venoocclusive disease (N=4), bleeding (N=2), thrombotic thrombocytopenic purpura (N=1), and suicide (N=1). The 5-year probabilities of OS and EFS were 20.6% and 14.0%, respectively (Fig. 1), and the 5-year CIR and NRM were 51.3% and 34.7%, respectively (Fig. 2).

Bottom Line: Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P = 0.031 and P = 0.031, respectively).Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse.Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background: The role of pre-transplant salvage chemotherapy has been controversial in relapsed acute leukemia.

Methods: We investigated post-transplant outcomes in 65 patients with acute leukemia treated with allogeneic hematopoietic cell transplantation (HCT) during first relapse or second remission.

Results: The 5-year cumulative incidence of relapse (CIR) was 52.3%. Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P = 0.031 and P = 0.031, respectively). Allogeneic HCT was performed in 14 patients after first relapse without salvage chemotherapy ("untreated relapse" group), 15 patients failed chemotherapy for reinduction of remission before HCT ("refractory relapse" group), and 36 patients attained second remission with salvage chemotherapy before HCT ("second remission" group). The 5-year CIR for patients in the untreated relapse group (57.1%) was higher than that for those in the second remission group (42.3%), but it was lower than that for patients in the refractory relapse group (66.7%). Among patients who underwent allogeneic HCT in relapse, those with bone marrow (BM) blasts ≤30% had a lower 5-year CIR than those in florid relapse (BM blasts >30%) (57.7% vs. 70.6%).

Conclusion: Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse. Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.

No MeSH data available.


Related in: MedlinePlus