Impact of Consolidative Cellular Therapy with DLI or Second Transplant in Patients with AML Who Achieve Complete Remission Following Post-Transplant Relapse

• Published in: Blood 2024-11, Vol.144, p.3538-3538
• Main Authors: Murdock, H. Moses, Kim, Haesook T., Maurer, Katie, Kelkar, Amar H., Shapiro, Roman M., Gooptu, Mahasweta, Romee, Rizwan, Cutler, Corey S., Koreth, John, Ritz, Jerome, Antin, Joseph H., Ho, Vincent T., Nikiforow, Sarah, Wu, Catherine J., Soiffer, Robert J.
• Format: Article
• Language: English
• ISSN: 0006-4971
• DOI: 10.1182/blood-2024-204343

Introduction: Relapse of acute myeloid leukemia (AML) after allogeneic hematopoietic cell transplantation (HCT) portends a dismal prognosis. Donor lymphocyte infusions (DLI) and 2nd HCT (consolidative cellular therapy [CT]) have been deployed in relapsed leukemias. However, the impact of these interventions in post-HCT relapsed AML is not clear, particularly in those patients achieving morphologic CR (mCR). There are no randomized studies to guide which patients benefit from consolidative CT, thus we evaluated the outcome of these interventions for post-HCT AML relapse at our institution. Methods: All patients who underwent HCT for AML between 2010 and 2022 at Dana Farber Cancer Institute and experienced morphologic relapse post-HCT were included in this consecutive series (N = 464). 110 patients received DLI, 30 underwent 2nd HCT, and 324 received no post-relapse CT. Results: Transplant characteristics were similar between groups, except that patients receiving 2nd HCT were younger than those receiving DLI or no subsequent CT (median recipient age at 1st HCT 46.7, 57.3, and 61.4 years, respectively). For the entire cohort, 2-year overall survival (OS) was 16% (95% confidence interval [CI]: 13% - 19%), and median survival was 3.8 months (95% CI: 3.2 - 5.2). In a multivariable Cox model for OS, higher HCT-CI (≥3 vs. 0-2, Hazard Ratio [HR] 1.27, 95% CI: 1.03 - 1.58, p=0.03), being on steroid immunosuppression at relapse (HR 2.31, 95% CI: 1.54 - 3.47, p 12mo, HR 4.19, 95% CI: 2.49 - 7.04, p