Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation i
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ORIGINAL ARTICLE
Incidence, risk factors and outcome of extramedullary relapse after allogeneic hematopoietic stem cell transplantation in patients with adult acute lymphoblastic leukemia Jian Yu 1,2 & Xinyi Ge 1,2 & Yi Luo 1,2 & Jimin Shi 1,2 & Yamin Tan 1,2 & Xiaoyu Lai 1,2 & Yanmin Zhao 1,2 & Yishan Ye 1,2 & Yuanyuan Zhu 1,2 & Weiyan Zheng 1,2 & He Huang 1,2 Received: 12 May 2020 / Accepted: 21 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Acute lymphoblastic leukemia . Allogeneic hematopoietic stem cell transplantation . Extramedullary relapse
Introduction Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potential curative method for patients diagnosed with acute lymphoblastic leukemia (ALL). Although rates of complete remission (CR) have been reported to be between 78 and 93% in prospective clinical trials [1], relapse after allo-
* He Huang [email protected] 1
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China
2
Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
HSCT still exists. Majority of these patients with relapses succumb to the disease [2–6]. Clinically, bone marrow relapse (BMR) is the most common type of relapse. Currently, extramedullary relapses (EMR) affecting the
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