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Original Article

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Korean J Hematol 2010; 45(2):

Published online June 30, 2010

https://doi.org/10.5045/kjh.2010.45.2.95

© The Korean Society of Hematology

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

Je-Hwan Lee1, Sung-Soo Yoon2*, Chul Won Jung3, Jung-Hee Lee1, Dae-Young Kim1, Young-Shin Lee1, Sung Cheol Yun4, Inho Kim2, Seonyang Park2, Byoung Kook Kim2, Kihyun Kim3, Jin Seok Ahn3, and Kyoo-Hyung Lee1

Author Info. +

1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

4Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Sung-Soo Yoon, M.D. Department of Internal Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3079, Fax: +82-2-762-9662, ssysmc@snu.ac.kr

Received: March 11, 2010; Revised: March 17, 2010; Accepted: May 3, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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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.

Keywords Allogeneic HCT, Acute leukemia, First relapse, Second remission

Article

Original Article

Korean J Hematol 2010; 45(2): 95-101

Published online June 30, 2010 https://doi.org/10.5045/kjh.2010.45.2.95

Copyright © The Korean Society of Hematology.

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

Je-Hwan Lee1, Sung-Soo Yoon2*, Chul Won Jung3, Jung-Hee Lee1, Dae-Young Kim1, Young-Shin Lee1, Sung Cheol Yun4, Inho Kim2, Seonyang Park2, Byoung Kook Kim2, Kihyun Kim3, Jin Seok Ahn3, and Kyoo-Hyung Lee1

1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

4Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Correspondence to Sung-Soo Yoon, M.D. Department of Internal Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3079, Fax: +82-2-762-9662, ssysmc@snu.ac.kr

Received: March 11, 2010; Revised: March 17, 2010; Accepted: May 3, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Allogeneic HCT, Acute leukemia, First relapse, Second remission

Fig 1.

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Figure 1.

Overall survival and event-free survival curves.

Blood Research 2010; 45: 95-101https://doi.org/10.5045/kjh.2010.45.2.95

Fig 2.

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Figure 2.

Cumulative incidences of relapse and non-relapse mortality.

Blood Research 2010; 45: 95-101https://doi.org/10.5045/kjh.2010.45.2.95

Fig 3.

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Figure 3.

Cumulative incidence of relapse relative to salvage chemotherapy aimed at reinduction of complete remission (CR) before hematopoietic cell transplantation: second CR vs. untreated relapse vs. refractory relapse.

Blood Research 2010; 45: 95-101https://doi.org/10.5045/kjh.2010.45.2.95

Fig 4.

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Figure 4.

Cumulative incidence of relapse relative to bone marrow blast percentage before hematopoietic cell transplantation.

Blood Research 2010; 45: 95-101https://doi.org/10.5045/kjh.2010.45.2.95

Table 1 . Patient and transplantation characteristics..

Abbreviations: M, male; F, female; AML, acute myeloid leukemia; ALL, acute lymphoblastic leukemia; BAL, biphenotypic acute leukemia; HCT, hematopoietic cell transplantation; CR, complete remission; BuCy, busulfan-cyclophosphamide; TBI, total body irradiation; RIC, reduced-intensity conditioning; CSA, cyclosporine; MTX, methotrexate; CS, corticosteroid; BM, bone marrow; PB, peripheral blood; CB, cord blood..

Table 2 . Multivariate analysis of prognostic factors for survival probabilities and cumulative incidences..

Abbreviations: a)Cox proportional hazards regression model; b)Gray's method..

MTX, methotrexate; HCT, hematopoietic cell transplantation; CR2, second complete remission; GVHD, graft-versus-host disease..

Table 3 . Clinical outcomes after allogeneic hematopoietic cell transplantation according to disease status..

Abbreviation: CR: complete remission..
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