General AML

EBMT 2018 | Second allogeneic HCT improves survival in children with relapsed AML after first transplantation

On Tuesday 20 March 2018, at the 44th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), Lisbon, Portugal, Martin Sauer from Hannover Medical School, Pediatric Hematology and Oncology, Hannover, Germany, on behalf of his colleagues presented data of their retrospective analysis investigating the outcomes of children with relapsed acute myeloid leukemia (AML) after first allogeneic hematopoietic stem cell transplantation (allo-HCT) or second HCT.

In total, 336 children (median age = 8.6 years [range, 0.4-26.0]) experiencing relapse after first allo-HCT between 2005–present were enrolled and analyzed in this study. Primary endpoints of the study included overall survival (OS) and risk factor identification.

Key findings:
  • 4-year OS and event-free survival (EFS) in all children were 14% (standard error, SE = 0.02) and 2% (SE = 0.01) respectively
  • 4-year OS in children relapsing < 6 months or ≥ 6 months after first HCT: 7% vs 29% , P < 0.0001
  • 4-year OS in children receiving PBSC/Cord graft and children receiving BM graft: 23% (SE = 0.06) vs 49% (SE = 0.09), P = 0.036

Second allo-HCT was performed in 123(36.6%) children. Reasons for not performing a second HCT included disease progression and failure to achieve another remission (55%), other reasons such as parental decision and palliation (33%) and poor performance status (12%).

  • 4-year OS in patients with (n = 123) or without (n = 213) second HCT: 32% vs 3%, P < 0.0001
  • Causes of death after second HCT:
    • Underlying disease (relapse, progression, or persistence): 65%
    • HCT related cause: 22%
    • Other (infection, multi-organ failure, hemorrhage): 14%

Martin Sauer concluded his talk by stating that survival for children with AML experiencing relapse after first transplantation is very unlikely without undergoing a second HCT. Moreover, relapse after first HCT is an evocative risk factor. Also, children receiving HLA-identical sibling bone marrow graft have a higher chance of survival.

References
  1. Sauer M. et al. Relapse after first allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia: a retrospective I-BFM analysis of 336 children between 2005 and 2016. Oral abstract Ped4-3. EBMT 44th Annual Meeting, Lisbon, Portugal.