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Acute Leukemias

Outcomes and prognostic factors of adults with acute lymphoblastic leukemia who relapse after allogeneic hematopoietic cell transplantation. An analysis on behalf of the Acute Leukemia Working Party of EBMT

Leukemia volume 26, pages 1211–1217 (2012)Cite this article

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Abstract

To describe outcomes, treatment and prognostic factors that influence survival of adult patients with acute lymphoblastic leukemia (ALL), who relapsed after allogeneic hematopoietic cell transplantation (HCT), we retrospectively analyzed 465 ALL adult patients from European Group for Blood and Marrow Transplantation (EBMT) centers who relapsed after a first HCT performed in complete remission (CR1 65%, CR2/3 35%). Salvage treatments were: supportive care (13%), cytoreductive therapy (43%), donor lymphocyte infusion without or with prior chemotherapy (23%) and second HCT (20%). Median time from HCT to relapse was 6.9 months, median follow-up was 46 months and median survival after relapse was 5.5 months. Estimated 1-, 2- and 5-year post-relapse survival was 30±2%, 16±2% and 8±1%, respectively. In a multivariate analysis, adverse factors for survival were: late CR (CR2/3) at transplant (P<0.012), early relapse after transplant (<6.9 months, P <0.0001) and peripheral blast percent at relapse (P <0.0001). On the basis of multivariate model for survival, three groups of patients were identified with estimated 2 year survival of 6±2, 17±3 and 30±7%. Outcome of ALL patients relapsing after HCT is dismal and there is a need for new therapies. Our study provides the standard expectations in ALL relapse and may help in the decision of post-relapse therapy.

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Acknowledgements

We thank E Polge and B Samey from the office of the Acute Leukemia Working Party of EBMT for their continuous support and excellent data management. We highly appreciate the contribution by many physicians and data managers throughout the EBMT who made this analysis possible (see Appendix). Following EBMT publication rules, co-authorship was offered to centers contributing the highest number of patients.

Author Contributions

Conception and design, and data analysis and interpretation was done by A Spyridonidis, C Schmid, M Labopin, V Rocha and M Mohty. Administrative support was provided by V Rocha, M Labopin, A Spyridonidis and C Schmid. Study materials or patients were provided by A Spyridonidis, C Schmid, L Volin, I Yakoub-Agha, M Stadler, N Milpied, G Socie, P Browne, S Lenhoff, M Sanz, M Aljurf and M Mohty. A Spyridonidis, M Labopin, C Schmid, L Volin, I Yakoub-Agha, M Stadler, N Milpied, Gerard Socie, P Browne, S Lenhoff, M Sanz, M Aljurf, M Mohty and V Rocha contributed to the collection and assembly of data and manuscript writing.

Author information

Author notes

  1. M Mohty and V Rocha: These authors share senior authorship.

Authors and Affiliations

  1. Division of Hematology, BMT Unit, University of Patras, Patras, Greece

    A Spyridonidis

  2. Service d’Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, UMR-S 938, CEREST-TC EBMT, Hôpital Saint Antoine, Paris, France

    M Labopin

  3. Klinikum Augsburg, Medizinische Klinik, Augsburg, Germany

    C Schmid

  4. Department of Medicine, University Central Hospital, Helsinki, Finland

    L Volin

  5. Hôpital Claude Huriez, Service de Maladies du Sang, Lille, France

    I Yakoub-Agha

  6. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School, Hannover, Germany

    M Stadler

  7. CHU Bordeaux, Pessac, France

    N Milpied

  8. Department of Hematology – BMT, Hôpital St Louis, Paris, France

    G Socie

  9. Hope Directorate, St James's Hospital, Dublin, Ireland

    P Browne

  10. Department of Hematology, University Hospital, Lund, Sweden

    S Lenhoff

  11. Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain

    M A Sanz

  12. Section of Adult Hematology /BMT, King Faisal Specialist Hospital & Research Centre, Oncology, Riyadh, Saudi Arabia

    M Aljurf

  13. Centre Hospitalier et Universitaire (CHU) de Nantes, Service d’ Hématologie Clinique, Nantes, France

    M Mohty

  14. Faculté de Médecine, Université de Nantes, Nantes, France

    M Mohty

  15. Centre d’Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, Nantes, France

    M Mohty

  16. INSERM CRNCA UMR 892, Nantes, France

    M Mohty

  17. Clinical Research Unit, Eurocord Office, Hôpital Saint Louis, Paris, France

    V Rocha

  18. Hematopoietic Transplant Unit, Sirio-Libanes Hospital and Children's Cancer Hospital, University of Sao Paulo, Sao Paulo, Brazil

    V Rocha

Authors
  1. A Spyridonidis
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  2. M Labopin
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  3. C Schmid
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  5. I Yakoub-Agha
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  6. M Stadler
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  7. N Milpied
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  8. G Socie
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  9. P Browne
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  10. S Lenhoff
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  11. M A Sanz
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  12. M Aljurf
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  13. M Mohty
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  14. V Rocha
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Consortia

on behalf of the Immunotherapy Subcommittee of Acute Leukemia Working Party of European Blood and Marrow Transplant Group

Corresponding author

Correspondence to A Spyridonidis.

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Competing interests

The authors declare no conflict of interest.

Additional information

Presented in part at the meetings of the European Group for Blood and Marrow Transplantation in Goteborg/ Sweden, 2009, in Vienna/Austria, 2010 and in Paris/France, 2011.

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Spyridonidis, A., Labopin, M., Schmid, C. et al. Outcomes and prognostic factors of adults with acute lymphoblastic leukemia who relapse after allogeneic hematopoietic cell transplantation. An analysis on behalf of the Acute Leukemia Working Party of EBMT. Leukemia 26, 1211–1217 (2012). https://doi.org/10.1038/leu.2011.351

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