Relapse patterns and treatment strategies in patients receiving allogeneic hematopoietic stem cell transplantation for myeloid malignancies View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-03-29

AUTHORS

Esther Schuler, Sarah Boughoufala, Christina Rautenberg, Kathrin Nachtkamp, Ariane Dienst, Roland Fenk, Rainer Haas, Mustafa Kondakci, Ulrich Germing, Thomas Schroeder, Guido Kobbe

ABSTRACT

Allogeneic hematopoietic stem cell transplantation (aHSCT) cures a considerable number of patients with myeloid malignancies, but relapse is the most frequent cause of death. We retrospectively studied relapse rate, kinetics, treatment, and outcome after first aHSCT in 446 patients during a 13-year period. Relapse occurred in 167 patients after a median of 4.6 months (116 hematologic (HR), 38 molecular (MR), and 13 extramedullary relapses (XR)). Median survival after relapse was 8.4 months and 2-year overall survival was 25%. Regarding survival after relapse, type (MR/HR/XR) and timepoint of relapse ( 12 months), age ( 50), diagnosis (MDS/AML and sAML), and remission status at transplant (CR and untreated MDS vs. refractory disease) were relevant in univariate analyses, in multivariate analyses timepoint, and type of relapse, age, and diagnosis. One hundred fifty-six patients were treated, most frequently with hypomethylating agents (HMA, n = 109) or intensive chemotherapy (n = 12). Donor lymphocyte infusion (DLI) was administered to 99 patients. Second aHSCT was performed in three patients as first and in 21 as higher salvage treatment. A complete remission (CR) was achieved in 46 patients (30%). Among CR patients, 65% had received HMA and DLI. Median survival of patients achieving CR was 105 months and 2-year overall survival was 80%. We conclude that with HMA and DLI or second aHSCT, a substantial number of patients, who relapse after aHSCT, can re-achieve remission and long-term survival. Techniques to further improve the detection of minimal residual disease are urgently needed because early treatment of MR results in significantly better survival. More... »

PAGES

1225-1235

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00277-019-03670-6

DOI

http://dx.doi.org/10.1007/s00277-019-03670-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1113063430

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30923997


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29 schema:description Allogeneic hematopoietic stem cell transplantation (aHSCT) cures a considerable number of patients with myeloid malignancies, but relapse is the most frequent cause of death. We retrospectively studied relapse rate, kinetics, treatment, and outcome after first aHSCT in 446 patients during a 13-year period. Relapse occurred in 167 patients after a median of 4.6 months (116 hematologic (HR), 38 molecular (MR), and 13 extramedullary relapses (XR)). Median survival after relapse was 8.4 months and 2-year overall survival was 25%. Regarding survival after relapse, type (MR/HR/XR) and timepoint of relapse (</> 12 months), age (</> 50), diagnosis (MDS/AML and sAML), and remission status at transplant (CR and untreated MDS vs. refractory disease) were relevant in univariate analyses, in multivariate analyses timepoint, and type of relapse, age, and diagnosis. One hundred fifty-six patients were treated, most frequently with hypomethylating agents (HMA, n = 109) or intensive chemotherapy (n = 12). Donor lymphocyte infusion (DLI) was administered to 99 patients. Second aHSCT was performed in three patients as first and in 21 as higher salvage treatment. A complete remission (CR) was achieved in 46 patients (30%). Among CR patients, 65% had received HMA and DLI. Median survival of patients achieving CR was 105 months and 2-year overall survival was 80%. We conclude that with HMA and DLI or second aHSCT, a substantial number of patients, who relapse after aHSCT, can re-achieve remission and long-term survival. Techniques to further improve the detection of minimal residual disease are urgently needed because early treatment of MR results in significantly better survival.
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37 MR
38 age
39 agents
40 allogeneic hematopoietic stem cell transplantation
41 analysis
42 better survival
43 cause
44 cell transplantation
45 chemotherapy
46 complete remission
47 considerable number
48 death
49 detection
50 diagnosis
51 disease
52 donor lymphocyte infusion
53 early treatment
54 frequent cause
55 hematopoietic stem cell transplantation
56 infusion
57 intensive chemotherapy
58 kinetics
59 long-term survival
60 lymphocyte infusion
61 malignancy
62 median
63 median survival
64 minimal residual disease
65 months
66 myeloid malignancies
67 number
68 outcomes
69 overall survival
70 patients
71 patterns
72 period
73 rate
74 relapse
75 relapse patterns
76 relapse rate
77 remission
78 remission status
79 residual disease
80 salvage treatment
81 status
82 stem cell transplantation
83 strategies
84 substantial number
85 survival
86 technique
87 timepoints
88 transplant
89 transplantation
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92 type of relapse
93 types
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