Purpose: For relapsed or refractory acute leukemia, the curative treatment of choice is allogeneic hematopoietic stem cell transplantation if patients could tolerate transplant therapy feasibly and an HLA mutched donor available. If not, patients could just go into S95 clinical trial with novel agents or supportive care. However, the transplant related morbidity and mortality is higher and the eventfree and overall survival are worse than patient in remission. Materials and methods: We evaluated our 20 patients who are relapsed or refractory acute leukemia after the treatment of remission induction and high dose Ara-C and mitoxantrone (HAM) chemotherapy or prior autologous or allogeneic stem cell transplantation between February 2004 and October 2009. All these patients underwent allogeneic hematopoietic stem cell transplantation with matched related or unrelated donor. Results: Twenty patients included 11 male and 9 female with median age 40.8 years old (range 21~60). Diagnosis included AML (N = 15, including 4 therapy-related), ALL (N = 3), and CML-BP (n = 2). There were 16 patients (80%) having undergone high dose Ara-C plus mitoxantrone (HAM) chemotherapy. Four patients (20%) had had prior transplant treatment. Four patients were graft failure and died in 1 month. For the other 15 evaluable patients, 5 patients were leukemia free but one of them died of pulmonary invasive aspergillosis. Posttransplant relapse occurred in 10 patients (66.7%), but in 7 patients underwent salvage chemotherapy alone (n = 1) or salvage chemotherapy plus donor leukocyte infusion (n = 6) with 5 leukemia-free achieved. In general, 9 patients died of leukemia, 3 patients died of infection, and 1 patients died of unknown cause of hepatic failure. Three year event-free survival is 22% and overall survival 23%. Conclusions: As expected, the relapse rate is very high and most patients died of leukemia itself but some patients still could be salvaged by re-chemotherapy plus CD34-riched donor leukocyte infusion or second transplantation. Therefore, the plan of programmed prophylactic donor lymphocyte infusion is mandatory.
Full conference title:
Annual Meeting of the EBMT, 36th
- EBMT 36th (2010)