TY - JOUR
T1 - Outcome and Prognostic Factors for Patients Who Relapse after Allogeneic Hematopoietic Stem Cell Transplantation
AU - Thanarajasingam, Gita
AU - Kim, Haesook T.
AU - Cutler, Corey
AU - Ho, Vincent T.
AU - Koreth, John
AU - Alyea, Edwin P.
AU - Antin, Joseph H.
AU - Soiffer, Robert J.
AU - Armand, Philippe
N1 - Funding Information:
Financial disclosure: Supported by NIH grant P01 CA142106 and the Jock and Bunny Adams Research Endowment. P.A. is supported by a career development award from the Conquer Cancer/ASCO Foundation .
PY - 2013/12
Y1 - 2013/12
N2 - Disease relapse remains a major obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT), yet little is known about the relevant prognostic factors after relapse. We studied 1080 patients transplanted between 2004 and 2008, among whom 351 relapsed. The 3-year postrelapse overall survival (prOS) rate was 19%. Risk factors for mortality after relapse included shorter time to relapse, higher disease risk index at HSCT, myeloablative conditioning, high pretransplantation comorbidity index, and graft-versus-host disease (GVHD) occurring before relapse. Important prognostic factors did not vary by disease type. Based on this, we could stratify patients into 3 groups, with 3-year prOS rates of 36%, 14%, and 3% (P<.0001). This score was validated in an historical cohort of 276 patients. Postrelapse donor lymphocyte infusion or repeat HSCT was associated with improved prOS, as was the development of GVHD after relapse. These differences remained significant in models that accounted for other prognostic factors and in landmark analyses of patients who survived at least 2months from relapse. The results of this study may aid with prognostication and management of patients who relapse after HSCT and motivate the design of clinical trials aimed at relapse prevention or treatment in higher-risk patients.
AB - Disease relapse remains a major obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT), yet little is known about the relevant prognostic factors after relapse. We studied 1080 patients transplanted between 2004 and 2008, among whom 351 relapsed. The 3-year postrelapse overall survival (prOS) rate was 19%. Risk factors for mortality after relapse included shorter time to relapse, higher disease risk index at HSCT, myeloablative conditioning, high pretransplantation comorbidity index, and graft-versus-host disease (GVHD) occurring before relapse. Important prognostic factors did not vary by disease type. Based on this, we could stratify patients into 3 groups, with 3-year prOS rates of 36%, 14%, and 3% (P<.0001). This score was validated in an historical cohort of 276 patients. Postrelapse donor lymphocyte infusion or repeat HSCT was associated with improved prOS, as was the development of GVHD after relapse. These differences remained significant in models that accounted for other prognostic factors and in landmark analyses of patients who survived at least 2months from relapse. The results of this study may aid with prognostication and management of patients who relapse after HSCT and motivate the design of clinical trials aimed at relapse prevention or treatment in higher-risk patients.
KW - Allogeneic hematopoietic stem cell transplantation
KW - Donor lymphocyte infusion
KW - Prognostic factors
KW - Relapse
UR - http://www.scopus.com/inward/record.url?scp=84887509847&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887509847&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2013.09.011
DO - 10.1016/j.bbmt.2013.09.011
M3 - Article
C2 - 24076323
AN - SCOPUS:84887509847
SN - 1083-8791
VL - 19
SP - 1713
EP - 1718
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -