Korean J Hematol.  2010 Jun;45(2):95-101. 10.5045/kjh.2010.45.2.95.

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

• KMID: 2083541
• DOI: http://doi.org/10.5045/kjh.2010.45.2.95

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 < or =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.

Keyword

Allogeneic HCT; Acute leukemia; First relapse; Second remission

MeSH Terms

Bone Marrow
Cell Transplantation
Cytogenetics
Humans
Incidence
Leukemia
Multivariate Analysis
Recurrence
Transplants

Figure

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  Fig. 1 Overall survival and event-free survival curves.

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  Fig. 2 Cumulative incidences of relapse and non-relapse mortality.

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  Fig. 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.

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  Fig. 4 Cumulative incidence of relapse relative to bone marrow blast percentage before hematopoietic cell transplantation.

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