Kharfan-Dabaja MA, et al. - Researchers compared overall survival (OS) following a second allogeneic hematopoietic cell transplant (allo-HCT2) or donor lymphocyte infusion (DLI) in patients with acute myeloid leukemia (AML) who relapsed after a first allogeneic hematopoietic cell transplant (allo-HCT). Findings revealed that the patient-, disease-, and treatment-related characteristics were heterogeneous, which limited the ability to recommend one approach over another. Data also showed that patients relapsing 6 or more months from an allo-HCT1 or those in complete remission at the time of either allo-HCT2 or DLI seemed to have best outcomes.

Methods

• They performed a retrospective registry study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
• Study participants were 418 adults who received an allo-HCT2 (n=137) or DLI (n=281) for postallograft-relapsed AML.
• Data collection was carried out from November 21, 2015 to May 15, 2017, and analysis was performed June 1, 2017.
• Assessment of the analysis was performed on the principle of intent-to-first received intervention.
• As main outcomes and measures, they assessed the number of patients with relapsed AML who were alive after 2 years and 5 years from receiving an allo-HCT2 or DLI.

Results

• Study included 418 patients, 228 (54.5%) were men; mean age was 46.2 years (interquartile range, 36.5-56.9 years).
• No difference was apparent in OS if an allo-HCT2 or DLI was prescribed (2-year OS with allo-HCT2, 26%; 5-year OS with allo-HCT2, 19%; 2-year OS with DLI, 25%; 5-year OS with DLI, 15%; P=.86).
• During complete remission, a better overall survival was seen with either of these procedures (hazard ratio, 0.55; 95% CI, 0.41-0.74; P<.001).
• Conversely, data showed that irrespective of the treatment prescribed, patients relapsing within less than 6 months after an allo-HCT1 had low OS (5-year OS: allo-HCT2, 9%; 95% CI, 1%-17% vs DLI, 4%; 95% CI, 1%-8%; P=.86).