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Interventions for AML After Relapse Work Best in Patients Who Achieved CR

Laura Joszt
Treatment options for patients with acute myeloid leukemia (AML) who relapse after an allogeneic hematopoietic cell transplant (allo-HCT) are limited, but those who are able to receive intensive interventions receive a second allo-HCT or donor lymphocyte infusion. A study in JAMA Oncology sought to compare the 2 options for patients who relapse.
Treatment options for patients with acute myeloid leukemia who relapse after an allogeneic hematopoietic cell transplant (allo-HCT) are limited, but those who are able to receive intensive interventions receive a second allo-HCT (allo-HCT2) or donor lymphocyte infusion (DLI). A study in JAMA Oncology sought to compare the 2 options for patients who relapse.

The retrospective observational study included 418 patients who were reported to the Acute Leukemia Working Part of the EBMT, a voluntary working group of more than 500 transplant centers.

Relapse occurs in 25% to 30% of patients who receive allo-HCT, and “outcomes are largely dependent on remission status at the time of allografting,” the authors explained.

A total of 137 patients received allo-HCT2 and 281 patients received DLI. The patients who underwent allo-HCT2 had a higher incidence of remission at the time of intervention and relapse occurred at a later time compared with allo-HCT1.

Compared with the DLI group, a higher proportion of allo-HCT2 patients were in complete remission (CR) at the time of intervention and remained in CR after (38.7% of allo-HCT2 vs 18.1% of DLI). In addition, 38.7% of allo-HCT2 patients who were not in CR at the time of intervention achieved CR after treatment compared with just 24.2% of the DLI group.

While the researchers did not find any significant difference in overall survival (OS) between the allo-HCT2 and DLI groups, they did note that OS was significantly better when either procedure was offered in CR.

Among all patients who died, relapse was the cause for 55.7% of patients in the allo-HCT2 group and for 75.8% of the DLI group. Patients who underwent DLI had significantly higher relapse-related deaths at 2 years (59% vs 40%) and at 5 years (66% vs 46%) after transplantation.

Overall, the researchers were not able to recommend one intervention over the other due to the heterogeneity of patients and disease- and treatment-related characteristics.

“Best results seem to be achieved in patients who relapse after 6 months from an allo-HCT1 or those who attain CR prior to an allo-HCT2 or DLI,” the authors concluded. “In patients who relapse within less than 6 months or receive an intervention while having active disease, OS rates are low.”

Reference

Kharfan-Dabaja MA, Labopin M, Polge E, et al. Association of second allogeneic hematopoietic cell transplant vs donor lymphocyte infusion with overall survival in patients with acute myeloid leukemia relapse [published online July 12, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2091.

 
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