No clear benefit of cellular therapy consolidation for patients achieving remission after post-HCT AML relapse
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic stem cell transplant (HSCT) portends a dismal prognosis. One approach for reinvigorating a graft-versus-leukemia response is consolidation with donor lymphocyte infusions (DLI) or second HSCT (HSCT2). However, the role of DLI/HSCT2 in patients who achieve complete remission (CR) after salvage therapy is unclear. In this retrospective study, we evaluated the outcomes of 464 patients with post-HSCT AML relapse, focusing on those who achieved CR before consolidation with cellular therapy. In multivariable analysis (MVA), achieving CR after post-HSCT1 relapse was associated with improved overall survival (OS; hazard ratio [HR], 0.42; P< .0001). Of 133 patients (29%) who achieved CR after posttransplant AML relapse and before cellular therapy, 64 received DLI, 28 underwent HSCT2, and 41 received neither. Four-year outcomes from CR for the entire cohort (n = 133) were: OS 29%, relapse-free survival (RFS) 22%, cumulative incidence of relapse 58%, and nonrelapse mortality (NRM) 20%. In MVA, there was no association between receipt of DLI (HR, 0.87; P = .59) or HSCT2 (HR, 1.08; P = .83) and OS. Furthermore, we did not identify a benefit with DLI or HSCT2 with respect to RFS, relapse, or NRM. Patients with donor chimerism <90% at the time of CR had reduced 4-year OS (20% vs 32%; P = .03), as did measurable residual disease-positive patients (17% vs 62%; P = .024). Our results question the benefit of consolidation with DLI or HSCT2 in patients with AML who achieve CR, and we identify high-risk subgroups that should be the focus of future studies with larger cohorts.
Source: Blood Advances
Authors: H. Moses Murdock, Haesook T. Kim, Katie Maurer, Amar Kelkar, Roman M. Shapiro, Mahasweta Gooptu, Rizwan Romee, Prashant K. Nageshwar, Heather M. Garrity, Shai Shimony, Marlise R. Luskin, Eric S. Winer, Rahul S. Vedula, Maximillian Stahl, Evan C. Chen, Virginia Volpe, Jacqueline S. Garcia, Martha Wadleigh, Daniel J. DeAngelo, Richard M. Stone, Catherine J. Wu, Corey S. Cutler, John Koreth, Jerome Ritz, Joseph H. Antin, Vincent T. Ho, Sarah Nikiforow, Robert J. Soiffer
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W4415749411