Incidence of extramedullary relapse after haploidentical SCT for advanced AML/myelodysplastic syndrome

Abstract

Extramedullary (EM) relapse of leukemia after allo-SCT in patients with AML/myelodysplastic syndrome has been increasingly reported. The reduced effectiveness of the GVL effect in EM sites, as compared with BM, has been suggested to underlie this problem. We retrospectively analyzed the pattern of relapse after haploidentical SCT (haplo-SCT), performed as the first or second SCT. Among 38 patients who received haplo-SCT as their first SCT, the cumulative incidences of BM and EM relapse at 3 years were 40.5 and 10.9%, respectively. Among 19 patients who received haplo-SCT as their second SCT, the cumulative incidences of BM and EM relapse were 30.9 and 31.9%, respectively. Moreover, most of the patients who underwent repeat haplo-SCT for the treatment of EM relapse had further EM relapse at other sites. Post-relapse survival did not differ significantly with different patterns of relapse. The frequent occurrence of EM relapse after haplo-SCT, particularly when performed as a second SCT, suggests that the potent GVL effect elicited by an HLA disparity also occurs preferentially in BM. Our findings emphasize the need for a treatment strategy for EM relapse that recognizes the reduced susceptibility of EM relapse to the GVL effect.

Acute Myeloid Leukemia and Other Types of Disease Progression in Myeloproliferative Neoplasms

“…In CML, close attention to combined morphologic and clinical characteristics allows one to accurately diagnose unusual cases with overlapping AP and BP features or those presenting as medullary BP or myeloid sarcoma at the ;17), inv (16), or t(8;21), are seen rarely in patients with BP-CML and are not associated with a favorable prognosis. TKI therapy may lead to genomic instability and acquisition of cytogenetic abnormalities in a Ph-neg clone, which underscores a need for continued cytogenetic monitoring.…”

“…,16 Case 327 was a 34-year-old woman diagnosed with CP-CML, treated with nilotinib, who developed lymphoblastic BP with leptomeningeal involvement. She achieved a complete remission upon induction chemotherapy, including dasatinib, and underwent allogeneic matched unrelated HST.…”

Isolated Granulocytic Sarcoma of the Breast after Allogeneic Stem Cell Transplantation: A Rare Involvement Also Detected by 18FDG-PET/CT

“…Thus, systemic or combined modality therapy should be considered, particularly in patients with good performance status [10]. Donor lymphocyte infusion (DLI) has limited efficacy [14] and a second transplant often results in repeated relapse [15]. Our patient’s performance was good enough for combined modality treatment and we planned systemic chemotherapy followed by DLI.…”

Characteristic patterns of relapse after allogeneic hematopoietic SCT for adult T-cell leukemia–lymphoma: a comparative study of recurrent lesions after transplantation and chemotherapy by the Nagasaki Transplant Group

“…Previous studies suggested that differences in extramedullary and BM relapse were attributed to the preferential occurrence of the GVL effect after transplantation for AML with stronger GVL effects in the blood system (that is, BM and peripheral blood) over extramedullary sites. [31][32][33][34] Although the underlying mechanism has not yet been elucidated in detail, an uneven graft-versus-ATL effect may explain, at least partly, the lower frequency of leukemic relapse following allo-SCT than CHT.…”