374 Survival Advantage of the Addition of Cell Therapy to Chemotherapy in Adult Patients with Relapsed AML After Allogeneic Hematopoietic Cell Transplantation

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Ghada M Kunter, MD , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
Janelle Perkins, PharmD , BMT, Moffitt Cancer Center, Tampa, FL
Taiga Nishihori, MD , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Frederick Locke , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Teresa Field, MD PhD , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Joseph Pidala, MD, MS , Hematology/Oncology, Moffitt Cancer Center, Tampa, FL
Lia Perez , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Mohamed Kharfan-Dabaja , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Claudio Anasetti, MD , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Hugo Fernandez, MD , Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
Background: There is no standard of care for patients (pts) with relapsed acute myelogenous leukemia (AML) after allogeneic hematopoietic cell transplantation (allo HCT). Outcome is dismal with 2-year overall survival (OS) of < 10%. Rapid immunosuppression taper to induce graft-versus-leukemia effect, cell therapy (CT) ± chemotherapy, or chemotherapy(ChT)  alone have all been attempted, however, there is paucity of comparative analysis examining the outcomes of these strategies.

Methods: To evaluate the efficacy of different approaches, we conducted a single-institution retrospective analysis comparing the efficacy of different therapeutic options in these pts. We assessed the impact of CT versus ChT on their response and outcomes using uni- and multivariate analysis.

Results: We report the outcomes of 85 adult AML pts; median age was 50 (range: 19-69) years relapsed post allo HCT. Median time from transplant to relapse was 4.3 (range, 0.6-45) months (mo). Twenty eight (32%) pts received ChT with either hypomethylating agents (HMA) or other ChT; 21 (24%) pts received CT, including donor lymphocyte infusion (DLI) or CD34+ stem cells ± ChT; 36 (42%) pts received supportive care only. The median post HCT follow up of surviving pts was 9 (range: 2-85) mo. Complete remission (CR) rate for all pts who received any therapy was 40% (62% of CT group compared to 22% receiving ChT alone (p=0.002)). CT produced higher CR rate compared to ChT alone (p=0.007). The median time to relapse after achieving a second CR post therapy for all pts was 13 mo with 14% , 40% and 70% relapsed by 6, 12 and 24 months respectively. Median OS after relapse for all pts was 3.7 mo with the best outcome noted in the CT group at 10.2 mo compared to 3.6 mo for those received ChT alone. Univariate analysis showed that receiving either CT or ChT compared to no therapy improved OS (p<0.0001); however there was no difference between CT and ChT (p=0.06). Multivariate analysis showed that the pre-HCT cytogenetics, CIBMTR risk score, comorbidity index and donor type had no impact on the CR rate or outcomes. However, CT was the only significant covariate over ChT (p=0.0071).

Conclusions: These data suggest that pts who are able to receive CT in addition to ChT have the best chance of achieving CR. Future approaches should focus on prospectively combining these modalities to improve OS in AML pts relapsing post allo HCT.

See more of: Poster Session 2: Allogeneic Transplants
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