scholarly journals Novel Therapy with Interferon-α in Combination with Donor Lymphocyte Infusion for High Risk Acute Leukemia Patients Who Relapsed After Allogeneic Hematopoietic Stem Cell Transplantation

2012 ◽  
Vol 18 (2) ◽  
pp. S220 ◽  
Author(s):  
X. Tang ◽  
Q. Zhou ◽  
Z. Jin ◽  
Z. Fu ◽  
C. Ye ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Donor Lymphocyte Infusion ◽  
Interferon Α ◽  
Novel Therapy ◽  
Hematopoietic Stem

Treatment Approaches in Acute Leukemia Patients Relapsing Following Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5891-5891
Author(s):  
Pervin Topcuoglu ◽  
Mehmet Gunduz ◽  
Mehmet Ozen ◽  
Sinem Civriz Bozdag ◽  
Selami Kocak Toprak ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Donor Lymphocyte Infusion ◽  
Hematopoietic Stem ◽  
Treatment Approaches ◽  
Second Transplantation

Abstract Aim: We would like to present our center experiences in the approaches of relapsing and/or progressive acute leukemia patients after allogeneic hematopoietic stem cell transplantation (AHSCT). Patients: We have retrospectively evaluated 133 patients (86 Male; 47 Female) with acute leukemia who has been detected relapse and/or progression after AHSCT between June 1990 and October 2013. Median age was 30 years (16-63 years) at the transplant time. Their diagnosis were 89 AML (12 secondary AML), 41 ALL and 3 biphenotipic leukemia. Median time of relapse and/or progression was 165 days (13-4713 days) after ASCT. Relapse types were as extramedullary relapse (EMR) alone in 11, extramedullary with hematological relapse in 30 and hematological relapses (HR) alone in 92 patients. Results: Our treatment approaches were chemotherapy and/or donor lymphocyte infusion in 109, second ASCT from same or different donor in 16 and radiotherapy alone in two patients. However, six patients were not able to receive any therapy. We have observed that the numbers of donor lymphocyte infusion or second transplantation increased after the year of 1999 (Figure 1). The probability of three-month, six-month or one-year survival after the relapse&progression were calculated as 53.7%±4.4%, 35.1 %±4.3% and 24.2%±3.9%, respectively. Survival after the relapse or progression was median 102 days (ranging between 68.7 days and 135.3 days, 95% CI). The type of relapse (EMR alone, EMR plus HR versus HR alone) and leukemic types (AML vs ALL) did not effect survival (p>0.5). When we compared second transplantation with other approaches, survival after relapse did not change (p=0.8) (Figure 2). In addition, survival was not affected by the year of relapses as 1990-1999, 2000-2009 versus 2010-2014 (p=0.7). Conclusion: Treatment approaches in acute leukemia relapsing after transplantation vary from the cellular therapy to chemotherapy. But our experience was not able to show a difference between second transplantation and others. Moreover each center should be approached to the patients according to their experience and type of relapse until an effective treatment option will be defined. Figure 1. Treatment approaches according to years Figure 1. Treatment approaches according to years Figure 2. Overall survival according to treatment approaches Figure 2. Overall survival according to treatment approaches Disclosures No relevant conflicts of interest to declare.

Relapsed ACUTE Leukemia after Hematopoietic STEM CELL Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5545-5545
Author(s):  
Brenda Lizeth Acosta-Maldonado ◽  
Jhohan Estuardo Vásquez Diaz ◽  
Gilberto Israel Barranco ◽  
Luis Manuel Valero-Saldaña ◽  
Silvia Rivas-Vera
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Poor Prognosis ◽  
Hematopoietic Stem ◽  
Active Disease

Abstract BACKGROUND In recent decades the results in the treatment of acute leukemia's have improved, this due to the optimization of chemotherapy regimens, risk stratification, monitoring of minimal residual disease, development of new agents and best supportive care. Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk of relapse. Allogeneic hematopoietic stem cell transplantation (HSCT) is a standard option for patients at high risk relapse. However, patients who relapse after transplantation have a poor prognosis because of subsequent treatments do not confer a success survival. The EBMT has reported a 5.5 months median survival after relapse, overall survival of 8% of ALL and 10-20% to AML to 3 years. AIMS Report outcomes of patients with relapsed acute leukemia after hematopoietic stem cell transplantation (HSCT). METHODS Retrospective analysis of our hematopoietic stem cell transplantation database was undertaken, containing 81 patients with acute leukemia presenting of a period of 10 years. RESULTS We Identified 81 patients, 47 (58%) were men. Median age for ALL was 20 years (7-55 yr) and for AML patients was 34 (15-64yr). ALL was the most frequent diagnosis (61%), 28 patients had AML (35%), other leukemias (4%). 44% patients with ALL had Ph'Chr+. 60% of all patients underwent myeloablative regimen transplantation in first CR and 30% in second remission. The 95% of HSCT was performed allogeneic transplantation and the rest was autologous. In most cases the source of stem cells was peripheral blood. Post-transplant relapse occurred in 51% and 54% of patients with ALL and AML, 10 and 12 months respectively. A total of 6 patients was underwent to second transplant with reduce intensity regimen with very poor response. Table 1 was shows the principal features of patients. Table 1. CHARACTERISTIC ALL=49 % (n) AML =28 % (n) Other leukemia =3 % (n) Age at HSCTMedian (Range) 22 (15-55) 34 (17-64) 18 (16-35) Response before HSCT First CR 63 (31) 53 (15) 100 (3) Second CR 29 (14) 36 (10) 0 Third or more CR 2 (1) 4 (1) 0 Active disease 2 (1) 7 (2) 0 Allogeneic 98% (48) 93 (26) 66.7 (2) Autologous 2 (1) 7.1 (2) 33.2 (1) GVHD Acute 26.5 (13) 17.9 (5) 22.2 (1) Chronic 22.9 (11) 39.3 (11) 0 Relapsed Media time at relapsed 51 (25) 10 months 53.6 (15) 12 months 66.7 (2) Post-Relapse Treatment Without treatment Palliative CT Cytotoxic CT 32 (8) 24 (6) 44 (11) 26.7 (4) 13.3 (2) 60 (9) 0 100 (2) Response after re-induction CT CR Active disease 20 (5) 48 (12) 32 (8) 33.3 (5) 33.3 (5) 33.3 (5) 0 100 (2) 0 Second HSCT 4.1 (2) 14.3 (4) Relapsed at second HSCT 50 (1) 50 (2) Outcome Alive Dead 55.1 (27) 44.9 (22) 39.3 (11) 60.7 (17) 33.3 (1) 66.7 (2) 3-years OS 5-years OS Median 56% 43% 50 months A 3 years 44% A 5 years 34% 36 months 20 months RFS 1-year Median 56% 22 months 28% 5 Months 33% 10 months NRM Mortality to relapse 9.5 (2) 90.5 (19) 23.5 (4) 76.5 (13) O 100 (2) CONCLUSION Our results confirm that treatment options for high risk acute leukemic patients who relapse early after HSCT are limited with extremely poor prognosis, special in patient relapsed early post-transplant. More studies are needed to determinate the best treatment option for patient who relapse after HSCT. Disclosures No relevant conflicts of interest to declare.

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