Duration of remission predictive of second HSCT in pediatric leukemia, myelodysplastic syndrome
ORLANDO — Duration of remission prior to post-transplant relapse, as well as survival after relapse, appeared to be strong independent predictors of whether pediatric patients with high-risk leukemia or myelodysplastic syndrome can receive a second allogeneic hematopoietic stem cell transplant, according to results of a retrospective study presented at TCT | Transplantation & Cellular Therapy Meetings.
Among this patient population, those who received a second HSCT achieved a 3-year OS rate six times higher than those who did not undergo a second transplant.
Although survival outcomes after second transplantation still are not ideal for pediatric patients, they are improving, according to researchers.
“Relapse remains the most common cause of death after allogeneic HSCT,” Akshay Sharma, MBBS, instructor in the bone marrow transplant department at St. Jude Children’s Research Hospital, said during a presentation. “About 20% to 30% of pediatric patients undergoing allo-HSCT experience relapse of their leukemia. The data on factors that determine outcomes after post-transplant relapse are scarce.”
Sharma and colleagues retrospectively analyzed 221 pediatric patients with acute leukemia or myelodysplastic syndrome who relapsed after first HSCT between 1990 and 2008 to identify factors associated with survival after relapse.
Patients experienced relapse at a median 3.9 months after transplantation.
Sixty percent (n = 132) received chemotherapy or supportive care after relapse, whereas 13% (n = 28) received donor lymphocyte infusion.
Only 28% (n = 61) of patients received a second transplant. These patients appeared more likely to have been in first remission when they received first transplant (P = .02), to have relapsed more than 6 months after first transplant (P < .001), to have experienced acute (P = .05) or chronic (P = .01) graft-versus-host disease, and to have relapsed between 2011 and 2018 (P = .001).
Eighteen of the 61 patients who received a second transplant remained alive at last follow-up, compared with only seven of those who received other therapies instead of a second transplant.
A multivariable model showed significant associations between OS and longer interval from HSCT to relapse (P < .001), ability to receive a second transplant (P < .001) and receipt of transplant between 2011 and 2018 (P < .001).
Disease status, type of HSCT, donor and graft source did not appear predictive of survival after post-transplant relapse.
“This cohort ended before [chimeric antigen receptor T-cell therapy] began, and none of these patients received immunotherapy,” Sharma said. “However, many of these second transplants did occur in the last decade, so that does play a big role in improving outcomes in patients who have relapsed after the second transplant.”– by John DeRosier
Sharma A, et al. Abstract 116. Presented at: TCT | Transplantation & Cellular Therapy Meetings; Feb. 19-23, 2020; Orlando.
Sharma reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.