No clear benefit of cellular therapy consolidation for patients achieving remission after post-HCT AML relapse

Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic stem cell transplant (HSCT) portends a dismal prognosis. One approach for reinvigorating a graft-versus-leukemia response is consolidation with donor lymphocyte infusions (DLI) or second HSCT (HSCT2). However, the role of DLI/HSCT2 in patients who achieve complete remission (CR) after salvage therapy is unclear. In this retrospective study, we evaluated the outcomes of 464 patients with post-HSCT AML relapse, focusing on those who achieved CR before consolidation with cellular therapy. In multivariable analysis (MVA), achieving CR after post-HSCT1 relapse was associated with improved overall survival (OS; hazard ratio [HR], 0.42; P< .0001). Of 133 patients (29%) who achieved CR after posttransplant AML relapse and before cellular therapy, 64 received DLI, 28 underwent HSCT2, and 41 received neither. Four-year outcomes from CR for the entire cohort (n = 133) were: OS 29%, relapse-free survival (RFS) 22%, cumulative incidence of relapse 58%, and nonrelapse mortality (NRM) 20%. In MVA, there was no association between receipt of DLI (HR, 0.87; P = .59) or HSCT2 (HR, 1.08; P = .83) and OS. Furthermore, we did not identify a benefit with DLI or HSCT2 with respect to RFS, relapse, or NRM. Patients with donor chimerism <90% at the time of CR had reduced 4-year OS (20% vs 32%; P = .03), as did measurable residual disease-positive patients (17% vs 62%; P = .024). Our results question the benefit of consolidation with DLI or HSCT2 in patients with AML who achieve CR, and we identify high-risk subgroups that should be the focus of future studies with larger cohorts.

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Publication Details

Journal
Blood Advances
Published
2025-10-31
DOI
https://doi.org/10.1182/bloodadvances.2025018139
Citations
1
Primary Topic
Acute Myeloid Leukemia Research
Type
article
Field-Weighted Citation Impact
1.77

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article

No clear benefit of cellular therapy consolidation for patients achieving remission after post-HCT AML relapse

Jacqueline Suen Garcia, Sarah Nikiforow, Jerome Ritz, Prashant Nageshwar et al.
1 citations
Blood Advances
Acute Myeloid Leukemia Research
1.77
article

No clear benefit of cellular therapy consolidation for patients achieving remission after post-HCT AML relapse

Jacqueline Suen Garcia, Sarah Nikiforow, Jerome Ritz, Prashant Nageshwar, Eric S. Winer, Maximilian Stahl, Roman M. Shapiro, Marlise Rachael Luskin, Rahul S. Vedula, Corey S. Cutler, John Koreth, Vincent T. Ho, Mahasweta Gooptu, Haesook T. Kim, H. Moses Murdock, Catherine J. Wu, Martha Wadleigh, Shai O. Shimony, Evan Chris Chen, Katie Maurer, Rizwan Romee, Amar H. Kelkar, Heather Garrity, Robert J. Soiffer, Virginia Olivia Volpe, Richard Maury Stone, Daniel J. DeAngelo, Joseph H. Antin
article en
1 citations

Abstract

Acute myeloid leukemia (AML) relapse after allogeneic hematopoietic stem cell transplant (HSCT) portends a dismal prognosis. One approach for reinvigorating a graft-versus-leukemia response is consolidation with donor lymphocyte infusions (DLI) or second HSCT (HSCT2). However, the role of DLI/HSCT2 in patients who achieve complete remission (CR) after salvage therapy is unclear. In this retrospective study, we evaluated the outcomes of 464 patients with post-HSCT AML relapse, focusing on those who achieved CR before consolidation with cellular therapy. In multivariable analysis (MVA), achieving CR after post-HSCT1 relapse was associated with improved overall survival (OS; hazard ratio [HR], 0.42; P< .0001). Of 133 patients (29%) who achieved CR after posttransplant AML relapse and before cellular therapy, 64 received DLI, 28 underwent HSCT2, and 41 received neither. Four-year outcomes from CR for the entire cohort (n = 133) were: OS 29%, relapse-free survival (RFS) 22%, cumulative incidence of relapse 58%, and nonrelapse mortality (NRM) 20%. In MVA, there was no association between receipt of DLI (HR, 0.87; P = .59) or HSCT2 (HR, 1.08; P = .83) and OS. Furthermore, we did not identify a benefit with DLI or HSCT2 with respect to RFS, relapse, or NRM. Patients with donor chimerism <90% at the time of CR had reduced 4-year OS (20% vs 32%; P = .03), as did measurable residual disease-positive patients (17% vs 62%; P = .024). Our results question the benefit of consolidation with DLI or HSCT2 in patients with AML who achieve CR, and we identify high-risk subgroups that should be the focus of future studies with larger cohorts.

Blood AdvancesVol. 10(4)
Harvard University (US), Yale Cancer Center (US), Yale University (US), Dana-Farber Cancer Institute (US), Dana-Farber/Harvard Cancer Center (US)
Dana-Farber Cancer Institute, Parker Institute for Cancer Immunotherapy, Daiichi-Sankyo
Openalex Percentile: Top 11%
Acute Myeloid Leukemia Research
1.77
DOIOpen Access PDFOpenAlex
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