1.
Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC
Kaphan, E., Bettega, F., Forcade, E., Labussière-Wallet, H., Fegueux, N., Robin, M., De Latour, R. P., Huynh, A., Lapierre, L., Berceanu, A., et al
Transplantation and cellular therapy. 2023
Abstract
Late relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010 and December 31, 2016, considering data from the French national retrospective register ProMISe (SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy)). We included patients presenting LR, defined as a relapse occurring at least two years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, 7,582 AHSCT were performed in 29 centers and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered as LR, representing an incidence of 4.2% from the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia, and 40 (13.8%) with acute lymphoid leukemia. Median delay from AHSCT to LR was 38.2 months (29.2-49.7) and 27.2% of patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (5.6-46.4). The most common salvage therapy was induction regimen (55.5%), with complete remission being obtained for 50.7%. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (7.1-49.1). Non-relapse mortality after second AHSCT was 18.2%. We identified in the Cox model some of the associated factors with delay of LR: the disease status not in first complete remission at first HSCT (odds ratio (OR) 1.31, 1.04-1.64, p=0.02) and the use of post-transplant cyclophosphamide (OR 2.23, 1.21-4.14, p=0.01). Chronic GVHD appeared to be a protective factor (OR 0.64, 0.42-0.96, p=0.04). Prognosis of LR is better than early relapses, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity.
2.
Allogeneic stem cell transplantation in therapy-related myelodysplasia after autologous transplantation for lymphoma: a retrospective study of the SFGM-TC
Jaimes-Albornoz, D., Mannone, L., Nguyen-Quoc, S., Chalandon, Y., Chevallier, P., Mohty, M., Meunier, M., Robin, M., Ledoux, M. P., Guillerm, G., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Therapy-related myelodysplastic syndrome (t-MDS) after autologous stem-cell transplantation (ASCT) is a rare complication with no curative option. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be considered for eligible patients and has been understudied in t-MDS. We report 47 consecutive patients with t-MDS after an ASCT who underwent allo-HSCT with a median age of 58 years (range: 30-71) at transplantation and a median follow-up of 22 months (range: 0.7-107). The median overall survival (OS) was 6.9 months (95% confidence interval, 0-19). OS rates were 45% (29-60%) and 30% (15-45%) at 1 and 3 years after transplantation, respectively. On univariate analysis prior therapy for t-MDS before allo-HSCT (p=0.02) and mismatched donors (p=0.004) were associated with poor OS. Three-year non-relapse mortality (NRM) and relapse rates were 44% (25-63%) and 41% (22-61%), respectively. Mismatched donors (p<0.001) were associated with higher NRM and a high-risk MDS (p=0.008) with a higher relapse risk. On multivariate analysis HLA mismatch was associated with higher NRM (HR 6.21; 95% CI 1.63-23.62; p=0.007). In conclusion, our results suggest that one third of the patients who develop t-MDS after an ASCT for lymphoma are cured after an allo-HSCT. The use of mismatched donors with standard GVHD prophylaxis should be avoided in such indication for allo-HSCT. It will be worth to see if the implementation of CY post-transplantation will improve the outcome with mismatched donors.