Abstract
Autologous hematopoietic cell transplantation (HCT) is suitable for consolidation of favorable-/intermediate-risk AML patients in CR1. However, ~50% of AML patients relapse after autologous HCT, and efficacy of subsequent salvage strategies including allogeneic HCT remains unclear. We studied 123 consecutive patients with newly diagnosed AML undergoing high-dose chemotherapy (HDCT)/autologous HCT in CR1. In relapsing patients afterwards, we analyzed salvage treatments and outcomes focusing particularly on salvage allogeneic HCT. Of 123 patients, 64 (52%) relapsed after autologous HCT. Subsequently, 13 (21%) received palliative therapy, whereas 51 (79%) proceeded to salvage therapy with a curative intent. Of the 47 patients with a curative intent and who did not proceed directly to allogeneic HCT, 23 (49%) achieved CR2 or had ongoing hematologic CR1 despite molecular relapse. Finally, 30 patients (47%) received allogeneic HCT with estimated 3-year leukemia-free and overall survival rates of 33% and 43%. Hematologic remission at allogeneic HCT and lack of acute GvHD had a positive impact on OS and LFS (p < 0.05). Our study suggests that almost 80% of AML patients can undergo salvage therapy following relapse after front-line HDCT/autologous HCT. Allogeneic HCT can provide cure in one third of patients relapsing after front-line HDCT/autologous HCT.
Highlights
Up to 80% of AML patients less than 60 years of age achieve complete hematological remission (CR1) following intensive induction chemotherapy [1], more than half of them will relapse [2]
high-dose chemotherapy (HDCT) followed by autologous hematopoietic cell transplantation (HCT) represents a suitable therapeutic option for consolidation of CR1 in good and intermediate-risk AML patients [4, 24, 31,32,33]
Patients with negative minimal residual disease (MRD) status following induction therapy benefit from HDCT/autologous HCT treatment [7, 31, 34]
Summary
Up to 80% of AML patients less than 60 years of age achieve complete hematological remission (CR1) following intensive induction chemotherapy [1], more than half of them will relapse [2]. Consolidation of CR1 with high-dose chemotherapy (HDCT) followed by autologous hematopoietic cell transplantation (HCT) is one option in patients with favorable- or intermediate-risk AML— in patients with minimal residual disease (MRD) negativity after intensive induction therapy. Relapse remains the major problem for patients with AML This is true for patients after HDCT/autologous HCT, with relapse rates up to 50% [12]. MRD testing is increasingly performed in patients with a higher risk of post-autologous HCT relapse, e.g., due to MRD positivity following induction therapy [13, 14], and has triggered the interest in maintenance strategies post-transplant. Hypomethylating agents or (in case of the respective mutation) FLT3 inhibitors have demonstrated promising results for patients with an increased relapse risk after allogeneic HCT [15,16,17,18], whereas these options still await exploration in patients after autologous HCT
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