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EBMT 2020 | AML relapse after HSCT: trends and predictive factors

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Ali Bazarbachi

Ali Bazarbachi, MD, PhD, of the American University of Beirut-Medical Center, Beirut, Lebanon, outlines the trends and predictive factors for outcomes of relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplant (HSCT) in young vs old patients. This interview was recorded via an online conference call with The Video Journal of Hematological Oncology (VJHemOnc).

Transcript (edited for clarity)

As we mentioned before, relapsed AML after allogenic stem cell transplant has a dismal prognosis. The recent years have witnessed significant changes in the characteristics of patients undergoing allogenic stem cell transplant. And new strategies for the management of post-transplant AML relapse have become available.

However, it is unclear to what extent these recent developments may influence the risk factors and outcome of AML relapse after allotransplant...

As we mentioned before, relapsed AML after allogenic stem cell transplant has a dismal prognosis. The recent years have witnessed significant changes in the characteristics of patients undergoing allogenic stem cell transplant. And new strategies for the management of post-transplant AML relapse have become available.

However, it is unclear to what extent these recent developments may influence the risk factors and outcome of AML relapse after allotransplant. Within that EBMT acute leukemia working party, we assess the influence of the year of relapse and the relapse characteristics on the outcomes of relapse AML after allogenic stem cell transplant.

We analyze the EBMT registry data of 8,162 adult AML patients, who suffered from hematological relapse between 2000 and 2018 after allogenic stem cell transplant performed in first complete remission from matched sibling , matched unrelated or haploidentical donors.

Median follow up for survivors was 35 months. What we observed is a steady increase over time, and two years survival from relapse for young patients, young patients I mean patients below 50. Their two years survival after relapse increased from 16% to 26%. Unfortunately we did not observe a similar increase in two years, survival after relapse for patients older than 50.

Importantly for younger patients, less than 50, the improvement over time and two years survival from relapse was particularly noted and that intermediate cytogenetic risk through, and an either patient with FLT3 wild-type or FLT3-ITD.

Also very important finding is that improvement over time for young patients below 50 was noted both for patients with early relapse within six months from transplant, as well as patient with late relapse, more than six months after transplant.

Finally, we observed very encouraging results with more than 30%, two year survival among patients who could receive a second allogenic stem cell transplant once they relapsed after the first allo.

 

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