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Patients with AML remain at risk for late recurrence after HSCT
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Patients with acute myeloid leukemia who underwent autologous stem cell transplantation with curative intent remained at risk for late leukemia recurrence, according to retrospective study results.
Leukemia recurrence usually occurs within 2 years after autologous HSCT for AML. The recurrence risk among patients who remained disease free for the first 2 years is not well defined.
Tomasz Czerw , MD, of the department of bone marrow transplantation and oncohematology at Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Gliwice, Poland, and colleagues from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation retrospectively reviewed data from 3,567 patients (median age, 45 years; range, 18-78; 51.6% women) who underwent autografting during first (86%; n = 3,087) or second (14%; n = 480) AML remission.
Peripheral blood served as the stem cell source for 68% (n = 2,414) of patients; the remaining 32% (n = 1,153) used bone marrow.
Median follow-up was 6.9 years (range, 2-21.5).
Patients who remained alive without recurrence at least 2 years after HSCT had a leukemia-free survival probability of 86% (95% CI, 84-87) at 5 years and 76% (95% CI, 74-78) at 10 years.
The cumulative incidence of recurrence was 11% (95% CI, 10-12) at 5 years and 16% (95% CI, 14-17) at 10 years. The nonrecurrence mortality incidence was 3% (95% CI, 3-4) at 5 years and 8% (95% CI, 7-10) at 10 years.
Survival in the overall study population appeared poorer than expected survival outcomes of the general European population.
In multivariate analyses, factors associated with decreased probability of leukemia-free survival included the use of peripheral blood as stem cell source (P < .0001), older age ( 60 years) at transplantation (P < .0001) and French-American-British subtype classifications M0, M6 or M7 (P < .0001).
These same factors appeared associated with increased risk for disease recurrence (P < .0001 for all).
Older age significantly affected the likelihood of nonrecurrence mortality (P < .0001).
“The results of the current study indicate that late recurrences remain a major concern after autologous HSCT in patients with AML," Czerw and colleagues wrote. “The observed survival was decreased compared with the expected survival of the general European population. This indicates the need for prolonged monitoring of the remission status in standard clinical practice.” – by Cameron Kelsall
Disclosure: Czerw reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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