Improved outcome in AML relapse after allogeneic transplant with high-intensity chemotherapy followed by 2nd allogeneic stem cell transplant or donor lymphocyte infusion

Acute myeloid leukemia (AML) relapse after allogeneic stem cell transplant (alloSCT) remains a major therapeutic challenge. While patients with longer remission after initial alloSCT are recommended to receive cell therapy (CT) such as 2ndalloSCT or donor lymphocyte infusion (DLI), survival for patients who relapse within 6 months of alloSCT has been dismal. We evaluated the outcomes of AML relapse after alloSCT to assess the impact of different treatments on long-term survival. One hundred and seventy-two patients with AML underwent alloSCT at the Penn State Cancer Institute from January 2014 to August 2019. Sixty-nine patients relapsed (median age, 60 years; range, 10–75). Of these, 4 patients underwent 2ndalloSCT, and 26 received DLI. One-year overall survival (OS) in all cases was 20.3% (95% CI: 11.8–30.4%). Patients with ECOG performance status (PS) 0–2 at relapse showed a better 1-year OS than those with PS 3–4. Median OS for patients who received chemotherapy only or chemotherapy with CT was 74 or 173.5 days, respectively (p < 0.001). Relapsed patients receiving conventional re-induction chemotherapy were categorized as the high-intensity chemotherapy (H) group, while those receiving treatments such as hypomethylating agents or targeted agents were categorized as the low-intensity chemotherapy (L) group. The H group showed a better 1-year OS compared with the L group. Patients who received H + CT showed a better 1-year OS of 52.9% than the other 3 groups (p < 0.001). Even for patients with post-alloSCT remission duration of less than 6 months, the statistical significance was preserved. Factors including age, donor source at 1stalloSCT, time to relapse, blast counts, PS at relapse, and treatment type after post-alloSCT relapse were used for a multivariate analysis, and matched or mismatched related donor and H + CT after alloSCT were identified as independent factors associated with OS. These findings support the use of H + CT as the treatment option of choice for AML patients who relapse after alloSCT when feasible.



Work Title Improved outcome in AML relapse after allogeneic transplant with high-intensity chemotherapy followed by 2nd allogeneic stem cell transplant or donor lymphocyte infusion
Open Access
  1. Neal Shah
  2. Kevin Rakszawski
  3. Myles Nickolich
  4. Christopher Ehmann
  5. Baldeep Wirk
  6. Seema Naik
  7. Witold Rybka
  8. Hong Zheng
  9. Joseph Mierski
  10. Brooke Silar
  11. Gina Mackey
  12. Robert Greiner
  13. Valerie Brown
  14. David Claxton
  15. Shin Mineishi
  16. Kentaro Minagawa
License In Copyright (Rights Reserved)
Work Type Article
  1. Annals of Hematology
Publication Date October 1, 2021
Publisher Identifier (DOI)
Deposited December 06, 2021




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Work History

Version 1

  • Created
  • Added Shah2021_Article_ImprovedOutcomeInAMLRelapseAft.pdf
  • Added Creator Neal Shah
  • Added Creator Kevin Rakszawski
  • Added Creator Myles Nickolich
  • Added Creator Christopher Ehmann
  • Added Creator Baldeep Wirk
  • Added Creator Seema Naik
  • Added Creator Witold Rybka
  • Added Creator Hong Zheng
  • Added Creator Joseph Mierski
  • Added Creator Brooke Silar
  • Added Creator Gina Mackey
  • Added Creator Robert Greiner
  • Added Creator Valerie Brown
  • Added Creator David Claxton
  • Added Creator Shin Mineishi
  • Added Creator Kentaro Minagawa
  • Published
  • Updated
  • Updated