Unrelated Donor Allogeneic Transplantation after Failure of Autologous Transplantation for Acute Myelogenous Leukemia: A Study from the Center for International Blood and Marrow Transplantation Research

James M. Foran, Steven Z. Pavletic, Brent R. Logan, Manza A. Agovi-Johnson, Waleska S. Pérez, Brian J. Bolwell, Martin Bornhäuser, Christopher N. Bredeson, Mitchell S. Cairo, Bruce M. Camitta, Edward A. Copelan, Jason Dehn, Robert P. Gale, Biju George, Vikas Gupta, Gregory A. Hale, Hillard M. Lazarus, Mark R. Litzow, Dipnarine Maharaj, David I. MarksRodrigo Martino, Richard T. Maziarz, Jacob M. Rowe, Philip A. Rowlings, Bipin N. Savani, Mary Lynn Savoie, Jeffrey Szer, Edmund K. Waller, Peter H. Wiernik, Daniel J. Weisdorf

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n= 242) or reduced-intensity conditioning (RIC; n= 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P= .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P= .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P= .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed.

Original languageEnglish (US)
Pages (from-to)1102-1108
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number7
DOIs
StatePublished - Jul 2013

Keywords

  • Acute myelogenous leukemia
  • Allogeneic
  • Autologous
  • Transplantation
  • Unrelated donor

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Foran, J. M., Pavletic, S. Z., Logan, B. R., Agovi-Johnson, M. A., Pérez, W. S., Bolwell, B. J., Bornhäuser, M., Bredeson, C. N., Cairo, M. S., Camitta, B. M., Copelan, E. A., Dehn, J., Gale, R. P., George, B., Gupta, V., Hale, G. A., Lazarus, H. M., Litzow, M. R., Maharaj, D., ... Weisdorf, D. J. (2013). Unrelated Donor Allogeneic Transplantation after Failure of Autologous Transplantation for Acute Myelogenous Leukemia: A Study from the Center for International Blood and Marrow Transplantation Research. Biology of Blood and Marrow Transplantation, 19(7), 1102-1108. https://doi.org/10.1016/j.bbmt.2013.04.022