Graft-versus-host disease and graft-versus-leukaemia effects in secondary acute myeloid leukaemia: a retrospective, multicentre registry analysis from the Acute Leukaemia Working Party of the EBMT.

Abstract

We assessed the susceptibility of secondary acute myeloid leukaemia (sAML) to graft-versus-leukaemia effects. Data from 2414 sAML patients in first (n=2194) or second (n=220) complete remission were included. They were given grafts from human leucocyte antigen (HLA)-matched sibling (MSD, n=1085), 10/10 unrelated donor (MUD, n=1066) or 9/10 mismatched unrelated donor (MMUD, n=263). The 100-day incidence of grade II-IV acute graft-versus-host disease (GVHD) was 25% while 2-year incidence of chronic GVHD was 38%. Relapse rates declined steadily by duration of follow-up and were significantly lower in patients with chronic GVHD (P<0·001). Limited (hazard ratio [HR]=0·66, P<0·001) and extensive (HR=0·52, P<0·001) chronic GVHD were associated with a lower incidence of relapse. Each grade III-IV acute (HR=7·04, P<0·001) as well as limited (HR=1·42, P=0·03) and extensive (HR=3·97, P<0·001) chronic GVHD were associated with higher non-relapse mortality (NRM). This translated to better overall survival (OS; HR=0·61, P<0·001) in patients with limited chronic GVHD. In contrast, grade III-IV acute and extensive chronic GVHD were associated with worse OS (HR=3·16, P<0·001 and HR=1·21, P=0·03, respectively). Further, in comparison to HLA-identical sibling recipients, MUD recipients had a lower risk of relapse (HR=0·82, P=0·03) but higher NRM (HR=1·38, P=0·004). In conclusion, these data demonstrate that sAML is susceptible to graft-versus-leukaemia effects.