Acute Myeloid Leukemia Coverage From Every Angle

Second Cellular Therapy After Early Relapse of AML and Myelodysplastic Syndrome

By: Vanessa A. Carter, BS
Posted: Monday, August 30, 2021

According to Melody Smith, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues, patient survival after stem cell transplantation relapse has improved over time. Published in Transplantation and Cellular Therapy, a retrospective analysis evaluated survival after relapse and the efficacy of second-course cellular therapy in acute myeloid leukemia (AML) and myelodysplastic syndrome. Despite discovering promising results, the investigators suggest that further research is necessary to develop a novel approach.

The investigators analyzed data from 104 patients with AML and 44 patients with myelodysplastic syndrome who underwent allogeneic hematopoietic cell transplantation but relapsed afterward. Grafts from peripheral blood and bone marrow stem cells were included and were either T-cell–depleted by CD34-positive selection or unmodified.

The median patient age at transplant was 60, and the median time to relapse was 6.5 months. A total of 30.4% of patients were administered a second cellular therapy after relapse, such as a second stem cell transplantation (n = 28) or donor leukocyte infusion (n = 17). Patients had a disease risk index of intermediate (n = 69) and high or very high (n = 70). In 113 patients, relapse was morphologic, whereas for 26 patients, relapse was evidence as measurable residual disease.

The median duration of follow-up after relapse was 21.7 months, and treatments included hypomethylating agents (n = 78), chemotherapy (n = 62), cellular therapy (n = 45), targeted therapy (n = 32), and venetoclax combinations (n = 12). Longer overall survival was observed in individuals who had isolated measurable residual disease, relapse in recent years, or relapse after allogeneic hematopoietic cell transplantation. Second cellular therapy also significantly increased overall survival (hazard ratio = 0.51) in univariable analysis, but not in multivariable analysis.

The 2-year overall survival rate was 44.9%, and univariable analysis demonstrated that disease burden appeared to correlate with survival. Ultimately, there was no significant association between overall survival and type of relapse, prerelapse characteristics, or type of cellular therapy received.

Disclosure: The study authors reported no conflicts of interest.

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