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Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia
Extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to remain a clinical challenge. The data on EMR in acute lymphoblastic leukemia (ALL) are currently limited. Herein, a retrospective analysis of 268 adult ALL patients who underwent allo-HSCT...
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| Published in: | Annals of hematology 2020-11, Vol.99 (11), p.2639-2648 |
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| container_issue | 11 |
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| container_title | Annals of hematology |
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| creator | Yu, Jian Ge, Xinyi Luo, Yi Shi, Jimin Tan, Yamin Lai, Xiaoyu Zhao, Yanmin Ye, Yishan Zhu, Yuanyuan Zheng, Weiyan Huang, He |
| description | Extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to remain a clinical challenge. The data on EMR in acute lymphoblastic leukemia (ALL) are currently limited. Herein, a retrospective analysis of 268 adult ALL patients who underwent allo-HSCT in our center between March 2008 and December 2017 was performed to analyze post-HSCT EMR. Ninety patients (33.58%) experienced relapse; 51(19.03%) experienced bone marrow relapse (BMR), whereas 39 (14.55%) experienced EMR. The 5-year cumulative EMR incidence (CEMRI) revealed that matched sibling donor (MSD)-HSCTs were more likely to develop EMR than unrelated donor (URD)- and haploidentical-related donor (HRD)-HSCTs (CEMRI: 24.02%, 7.69%, and 14.69% for MSD, URD, and HRD, respectively). Notably, MSD-HSCTs (URD vs MSD hazard ratio (HR) = 0.26,
p
= 0.015; HRD vs MSD HR = 0.46,
p
= 0.032), history of extramedullary disease (EMD) (HR = 2.45,
p
= 0.041), and T cell ALL (HR = 2.80,
p
= 0.012) were independent risk factors for EMR in the multivariate analysis. The median overall survival (OS) for all patients was 15.23 months. However, the OS of EMR patients was significantly longer (19.50 months) than that of BMR patients (12.90 months) (
p
= 0.003). Multivariate analyses revealed that the leading risk factors for post-relapse deaths were shorter intervals between HSCT and relapse (> 12 months vs ≤ 12 months, HR = 0.30,
p
|
| doi_str_mv | 10.1007/s00277-020-04199-9 |
| format | article |
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p
= 0.015; HRD vs MSD HR = 0.46,
p
= 0.032), history of extramedullary disease (EMD) (HR = 2.45,
p
= 0.041), and T cell ALL (HR = 2.80,
p
= 0.012) were independent risk factors for EMR in the multivariate analysis. The median overall survival (OS) for all patients was 15.23 months. However, the OS of EMR patients was significantly longer (19.50 months) than that of BMR patients (12.90 months) (
p
= 0.003). Multivariate analyses revealed that the leading risk factors for post-relapse deaths were shorter intervals between HSCT and relapse (> 12 months vs ≤ 12 months, HR = 0.30,
p
< 0.001) and BMR (HR = 0.41,
p
= 0.002). In conclusion, EMR patients have better survival than BMR patients. ALL patients with allo-HSCT from MSDs, a history of EMD, and the T cell type were significantly associated with EMR.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-020-04199-9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Hematology ; Medicine ; Medicine & Public Health ; Oncology ; Original Article</subject><ispartof>Annals of hematology, 2020-11, Vol.99 (11), p.2639-2648</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c324t-c92b152539577723be672b32e427075e15a4686b79d2698442ae2c760b1a78c23</citedby><cites>FETCH-LOGICAL-c324t-c92b152539577723be672b32e427075e15a4686b79d2698442ae2c760b1a78c23</cites><orcidid>0000-0002-2723-1621</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Yu, Jian</creatorcontrib><creatorcontrib>Ge, Xinyi</creatorcontrib><creatorcontrib>Luo, Yi</creatorcontrib><creatorcontrib>Shi, Jimin</creatorcontrib><creatorcontrib>Tan, Yamin</creatorcontrib><creatorcontrib>Lai, Xiaoyu</creatorcontrib><creatorcontrib>Zhao, Yanmin</creatorcontrib><creatorcontrib>Ye, Yishan</creatorcontrib><creatorcontrib>Zhu, Yuanyuan</creatorcontrib><creatorcontrib>Zheng, Weiyan</creatorcontrib><creatorcontrib>Huang, He</creatorcontrib><title>Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><description>Extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to remain a clinical challenge. The data on EMR in acute lymphoblastic leukemia (ALL) are currently limited. Herein, a retrospective analysis of 268 adult ALL patients who underwent allo-HSCT in our center between March 2008 and December 2017 was performed to analyze post-HSCT EMR. Ninety patients (33.58%) experienced relapse; 51(19.03%) experienced bone marrow relapse (BMR), whereas 39 (14.55%) experienced EMR. The 5-year cumulative EMR incidence (CEMRI) revealed that matched sibling donor (MSD)-HSCTs were more likely to develop EMR than unrelated donor (URD)- and haploidentical-related donor (HRD)-HSCTs (CEMRI: 24.02%, 7.69%, and 14.69% for MSD, URD, and HRD, respectively). Notably, MSD-HSCTs (URD vs MSD hazard ratio (HR) = 0.26,
p
= 0.015; HRD vs MSD HR = 0.46,
p
= 0.032), history of extramedullary disease (EMD) (HR = 2.45,
p
= 0.041), and T cell ALL (HR = 2.80,
p
= 0.012) were independent risk factors for EMR in the multivariate analysis. The median overall survival (OS) for all patients was 15.23 months. However, the OS of EMR patients was significantly longer (19.50 months) than that of BMR patients (12.90 months) (
p
= 0.003). Multivariate analyses revealed that the leading risk factors for post-relapse deaths were shorter intervals between HSCT and relapse (> 12 months vs ≤ 12 months, HR = 0.30,
p
< 0.001) and BMR (HR = 0.41,
p
= 0.002). In conclusion, EMR patients have better survival than BMR patients. ALL patients with allo-HSCT from MSDs, a history of EMD, and the T cell type were significantly associated with EMR.</description><subject>Hematology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc2O1TAMhSMEEpeBF2CVJQsKiZs2zRKN-BlpJDawjtxcd25m0qQkqWBeiackl8sab2xL5zuSfRh7LcU7KYR-X4QArTsBohNKGtOZJ-wgVQ-dGCb1lB2E6U03tHrOXpRyL4SEScGB_b6Jzh8pOnrLsy8PfEFXUy4c45Gnvbq0Ek8Lp18140rHPQTMjzxTwK0Qx6VS5hhCuqNI3vETrVjTljzVtpVKK3cUAm90LFvAWLH6FLmPfGsTxVr4T19PHJt15ej2Sjw8rtspzQHL2STQ_kCrx5fs2YKh0Kt__Yp9__Tx2_WX7vbr55vrD7ed60HVzhmY5QBDbwatNfQzjRrmHkiBFnogOaAap3HW5gijmZQCJHB6FLNEPTnor9ibi--W04-dSrWrL-cjMFLaiwWlRHOYpr5J4SJ1OZWSabFb9mt7kJXCnoOxl2BsC8b-DcaaBvUXqDRxvKNs79OeYzvpf9Qf5QqU6A</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Yu, Jian</creator><creator>Ge, Xinyi</creator><creator>Luo, Yi</creator><creator>Shi, Jimin</creator><creator>Tan, Yamin</creator><creator>Lai, Xiaoyu</creator><creator>Zhao, Yanmin</creator><creator>Ye, Yishan</creator><creator>Zhu, Yuanyuan</creator><creator>Zheng, Weiyan</creator><creator>Huang, He</creator><general>Springer Berlin Heidelberg</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2723-1621</orcidid></search><sort><creationdate>20201101</creationdate><title>Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia</title><author>Yu, Jian ; Ge, Xinyi ; Luo, Yi ; Shi, Jimin ; Tan, Yamin ; Lai, Xiaoyu ; Zhao, Yanmin ; Ye, Yishan ; Zhu, Yuanyuan ; Zheng, Weiyan ; Huang, He</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-c92b152539577723be672b32e427075e15a4686b79d2698442ae2c760b1a78c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Hematology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yu, Jian</creatorcontrib><creatorcontrib>Ge, Xinyi</creatorcontrib><creatorcontrib>Luo, Yi</creatorcontrib><creatorcontrib>Shi, Jimin</creatorcontrib><creatorcontrib>Tan, Yamin</creatorcontrib><creatorcontrib>Lai, Xiaoyu</creatorcontrib><creatorcontrib>Zhao, Yanmin</creatorcontrib><creatorcontrib>Ye, Yishan</creatorcontrib><creatorcontrib>Zhu, Yuanyuan</creatorcontrib><creatorcontrib>Zheng, Weiyan</creatorcontrib><creatorcontrib>Huang, He</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yu, Jian</au><au>Ge, Xinyi</au><au>Luo, Yi</au><au>Shi, Jimin</au><au>Tan, Yamin</au><au>Lai, Xiaoyu</au><au>Zhao, Yanmin</au><au>Ye, Yishan</au><au>Zhu, Yuanyuan</au><au>Zheng, Weiyan</au><au>Huang, He</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia</atitle><jtitle>Annals of hematology</jtitle><stitle>Ann Hematol</stitle><date>2020-11-01</date><risdate>2020</risdate><volume>99</volume><issue>11</issue><spage>2639</spage><epage>2648</epage><pages>2639-2648</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract>Extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to remain a clinical challenge. The data on EMR in acute lymphoblastic leukemia (ALL) are currently limited. Herein, a retrospective analysis of 268 adult ALL patients who underwent allo-HSCT in our center between March 2008 and December 2017 was performed to analyze post-HSCT EMR. Ninety patients (33.58%) experienced relapse; 51(19.03%) experienced bone marrow relapse (BMR), whereas 39 (14.55%) experienced EMR. The 5-year cumulative EMR incidence (CEMRI) revealed that matched sibling donor (MSD)-HSCTs were more likely to develop EMR than unrelated donor (URD)- and haploidentical-related donor (HRD)-HSCTs (CEMRI: 24.02%, 7.69%, and 14.69% for MSD, URD, and HRD, respectively). Notably, MSD-HSCTs (URD vs MSD hazard ratio (HR) = 0.26,
p
= 0.015; HRD vs MSD HR = 0.46,
p
= 0.032), history of extramedullary disease (EMD) (HR = 2.45,
p
= 0.041), and T cell ALL (HR = 2.80,
p
= 0.012) were independent risk factors for EMR in the multivariate analysis. The median overall survival (OS) for all patients was 15.23 months. However, the OS of EMR patients was significantly longer (19.50 months) than that of BMR patients (12.90 months) (
p
= 0.003). Multivariate analyses revealed that the leading risk factors for post-relapse deaths were shorter intervals between HSCT and relapse (> 12 months vs ≤ 12 months, HR = 0.30,
p
< 0.001) and BMR (HR = 0.41,
p
= 0.002). In conclusion, EMR patients have better survival than BMR patients. ALL patients with allo-HSCT from MSDs, a history of EMD, and the T cell type were significantly associated with EMR.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00277-020-04199-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2723-1621</orcidid></addata></record> |
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| title | Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia |
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