Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era

Objective/Background: Relapse is the most common cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT). No standard of care exists, and a wide range of treatments are used for post-alloHCT relapse. In the recent era, several novel therapies including targeted agent...

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Autores principales:	Sanghee Hong, Lisa Rybicki, Donna Corrigan, Betty K. Hamilton, Ronald Sobecks, Matt Kalaycio, Aaron T. Gerds, Rob M. Dean, Brian T. Hill, Brad Pohlman, Deepa Jagadeesh, Faiz Anwer, Navneet S. Majhail
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Allogeneic stem cell transplantation Post-transplant relapse Relapse Survival Diseases of the blood and blood-forming organs RC633-647.5 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/7a57caab7c1048adaf808b1df5de420c
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spelling	oai:doaj.org-article:7a57caab7c1048adaf808b1df5de420c2021-12-02T05:00:00ZSurvival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era1658-387610.1016/j.hemonc.2020.11.006https://doaj.org/article/7a57caab7c1048adaf808b1df5de420c2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1658387620301783https://doaj.org/toc/1658-3876Objective/Background: Relapse is the most common cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT). No standard of care exists, and a wide range of treatments are used for post-alloHCT relapse. In the recent era, several novel therapies including targeted agents are available for acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and myelodysplastic syndrome (MDS). Methods: We reviewed outcomes after alloHCT relapse, with or without use of these newer agents for ALL, AML, and MDS. In total, 115 adults with relapsed or refractory ALL (n = 17), AML (n = 67), and MDS (n = 31) at median 5 (range, 1–64) months after their first alloHCT in 2010–2018 were included. Results: Median follow-up was 19 (range, 6–80) months after relapse from alloHCT. Targeted agents were given to 29 (25%) patients. In multivariable analysis, use of targeted agent at any time point after relapse was not associated with survival. Matched unrelated (vs. matched sibling; hazard ratio [HR] 1.70; p = .027) or haploidentical donor grafts (vs. matched sibling; HR 2.69; p = .003), presence of grade II–IV acute graft-versus-host disease before relapse (HR 2.46; p < .001), and less than 12 months from HCT to relapse (<6 vs. > 12 months; HR 6.34; p < .001; 6–12 vs. > 12 months; HR 3.16; p = .005) were adverse prognostic factors for post-relapse survival. Conclusion: Outcomes after alloHCT relapse remain poor regardless of the novel agent use. Innovative treatment strategies are needed to improve outcomes after relapse post-alloHCT.Sanghee HongLisa RybickiDonna CorriganBetty K. HamiltonRonald SobecksMatt KalaycioAaron T. GerdsRob M. DeanBrian T. HillBrad PohlmanDeepa JagadeeshFaiz AnwerNavneet S. MajhailElsevierarticleAllogeneic stem cell transplantationPost-transplant relapseRelapseSurvivalDiseases of the blood and blood-forming organsRC633-647.5Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENHematology/Oncology and Stem Cell Therapy, Vol 14, Iss 4, Pp 318-326 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Allogeneic stem cell transplantation Post-transplant relapse Relapse Survival Diseases of the blood and blood-forming organs RC633-647.5 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Allogeneic stem cell transplantation Post-transplant relapse Relapse Survival Diseases of the blood and blood-forming organs RC633-647.5 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Sanghee Hong Lisa Rybicki Donna Corrigan Betty K. Hamilton Ronald Sobecks Matt Kalaycio Aaron T. Gerds Rob M. Dean Brian T. Hill Brad Pohlman Deepa Jagadeesh Faiz Anwer Navneet S. Majhail Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
description	Objective/Background: Relapse is the most common cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT). No standard of care exists, and a wide range of treatments are used for post-alloHCT relapse. In the recent era, several novel therapies including targeted agents are available for acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and myelodysplastic syndrome (MDS). Methods: We reviewed outcomes after alloHCT relapse, with or without use of these newer agents for ALL, AML, and MDS. In total, 115 adults with relapsed or refractory ALL (n = 17), AML (n = 67), and MDS (n = 31) at median 5 (range, 1–64) months after their first alloHCT in 2010–2018 were included. Results: Median follow-up was 19 (range, 6–80) months after relapse from alloHCT. Targeted agents were given to 29 (25%) patients. In multivariable analysis, use of targeted agent at any time point after relapse was not associated with survival. Matched unrelated (vs. matched sibling; hazard ratio [HR] 1.70; p = .027) or haploidentical donor grafts (vs. matched sibling; HR 2.69; p = .003), presence of grade II–IV acute graft-versus-host disease before relapse (HR 2.46; p < .001), and less than 12 months from HCT to relapse (<6 vs. > 12 months; HR 6.34; p < .001; 6–12 vs. > 12 months; HR 3.16; p = .005) were adverse prognostic factors for post-relapse survival. Conclusion: Outcomes after alloHCT relapse remain poor regardless of the novel agent use. Innovative treatment strategies are needed to improve outcomes after relapse post-alloHCT.
format	article
author	Sanghee Hong Lisa Rybicki Donna Corrigan Betty K. Hamilton Ronald Sobecks Matt Kalaycio Aaron T. Gerds Rob M. Dean Brian T. Hill Brad Pohlman Deepa Jagadeesh Faiz Anwer Navneet S. Majhail
author_facet	Sanghee Hong Lisa Rybicki Donna Corrigan Betty K. Hamilton Ronald Sobecks Matt Kalaycio Aaron T. Gerds Rob M. Dean Brian T. Hill Brad Pohlman Deepa Jagadeesh Faiz Anwer Navneet S. Majhail
author_sort	Sanghee Hong
title	Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
title_short	Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
title_full	Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
title_fullStr	Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
title_full_unstemmed	Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
title_sort	survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/7a57caab7c1048adaf808b1df5de420c
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Survival following relapse after allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in the contemporary era

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