Extramedullary relapse of acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes

Andrew C. Harris, Carrie L. Kitko, Daniel R. Couriel, Thomas M. Braun, Sung W. Choi, John Magenau, Shin Mineishi, Attaphol Pawarode, Gregory Yanik, John E. Levine

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Extramedullary relapse after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia is a contributor to post-transplant mortality but risk factors for, and outcomes of, this condition are not well characterized. We analyzed 257 consecutive patients undergoing allogeneic stem cell transplantation for acute myeloid leukemia at our institution to characterize extramedullary relapse, identify predictive variables and assess outcomes. The 5-year cumulative incidence of isolated extramedullary or bone marrow relapse was 9% and 29%, respectively. Extramedullary relapse occurred later than marrow relapse and most frequently involved skin and soft tissue. Factors predictive of extramedullary relapse after transplantation included previous extramedullary disease, French-American-British classification M4/M5 leukemia, high risk cytogenetics, and advanced disease status at the time of transplantation. Children were more likely than adults to develop extramedullary relapse, a finding probably explained by an overrepresentation of extramedullary disease prior to transplantation and M4/M5 leukemia in children. Acute graft-versus-host disease was not protective against relapse. Unlike medullary relapse, chronic graft-versus-host disease was not protective against extramedullary relapse. The survival rate after extramedullary relapse was 30% at 1 year and 12% at 2 years. Extramedullary relapse is a significant contributor to mortality after allogeneic transplantation for acute myeloid leukemia and appears to be resistant to the immunotherapeutic effect of allogeneic grafting. Effective strategies for patients with extramedullary relapse are needed to improve outcomes after transplantation.

Original languageEnglish (US)
Pages (from-to)179-184
Number of pages6
JournalHaematologica
Volume98
Issue number2
DOIs
StatePublished - Feb 1 2013

All Science Journal Classification (ASJC) codes

  • Hematology

Fingerprint Dive into the research topics of 'Extramedullary relapse of acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes'. Together they form a unique fingerprint.

  • Cite this

    Harris, A. C., Kitko, C. L., Couriel, D. R., Braun, T. M., Choi, S. W., Magenau, J., Mineishi, S., Pawarode, A., Yanik, G., & Levine, J. E. (2013). Extramedullary relapse of acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes. Haematologica, 98(2), 179-184. https://doi.org/10.3324/haematol.2012.073189