Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed/Refractory Acute Myeloid Leukemia: A Single-Centre Experience

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2023-01, Vol.23 (1), p.28-39
• Main Authors: Kopińska, Anna, Węglarz, Patryk, Koclęga, Anna, Wieczorkiewicz-Kabut, Agata, Woźniczka, Krzysztof, Armatys, Anna, Spałek, Adrianna, Grygoruk-Wiśniowska, Iwona, Grosicki, Sebastian, Butrym, Aleksandra, Czyż, Jarosław, Obara, Agata, Gromek, Tomasz, Helbig, Grzegorz
• Format: Article
• Language: English
• Subjects: Allo-HSCT; Allogeneic stem cell transplantation; AML; Cytomegalovirus Infections - complications; Disease Progression; Graft vs Host Disease - etiology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Leukemia, Myeloid, Acute; r/rAML; refractory/ relapsed AML; Retrospective Studies; Transplantation Conditioning - methods
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2022.08.014

Patients with relapsed/refractory acute myeloid leukemia (r/r AML) are characterized as having a poor prognosis. The only viable option of treatment for these patients is allogenic stem cell transplantation (allo-HSCT). Therefore, we have attempted to analyse factors related to both the disease itself and the transplantation procedure that could have an influence on the improvement of outcomes in this group of patients. Sixty-four patients with r/r AML underwent allo-HSCT at our center in 2012 to 2021. Fifty-two had active disease at the beginning of theallo-HSCT procedure, with amedian number of blasts in bone marrow (BM) of 18, and 12 had therapeutic aplasia after the last reinduction (blasts < 5% in BM). The probability of overall survival (OS) at 2 years was 25%. The median follow-up for survivors was 21.5 months. Progression-free survival (PFS) estimates were above 46%. The main cause of death was disease progression (49%). A statistically significant effect on premature death was reported for the diagnosis of secondary AML (sAML) and cytomelovirus (CMV) reactivation post allo-HSCT. On the other hand, chronic graft versus host disease (cGVHD) decreased the risk of disease progression. sAML and CMV reactivation were found to have opposite effects. We present our single-center data on the safety and efficacy of allogenic stem cell transplantation in the r/r AML. The retrospective analysis included 64 patients. Our results confirm that secondary AML and the number of pretransplantation treatment lines increased the risk of progression, cGVHD showed the opposite effect. We confirm that patients with r/r AML should be transplanted as soon as possible, even after the first unsatisfactory induction.