Central nervous system relapse in adults with acute lymphoblastic leukemia after allogeneic hematopoietic stemcell transplantation

Amir Hamdi, Raya Mawad, Roland Bassett, Antonio di Stasi, Roberto Ferro, Aimaz Afrough, Ron Ram, Bouthaina Dabaja, Gabriela Rondon, Richard Champlin, Brenda M. Sandmaier, Kristine Doney, Merav Bar, Partow Kebriaei

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Central nervous system (CNS) relapse after allogeneic hematopoietic stem cell transplantation (HSCT) confers a poor prognosis in adult patients with acute lymphoblastic leukemia (ALL). Preventing CNS relapse after HSCT remains a therapeutic challenge, and criteria for post-HSCT CNS prophylaxis have not been addressed. In a 3-center retrospective analysis, we reviewed the data for 457 adult patients with ALL who received a first allogeneic HSCT in first or second complete remission (CR). All patients received CNS prophylaxis as part of their upfront therapy for ALL, but post-transplantation CNS prophylaxis practice varied by institution and was administered to 48% of the patients. Eighteen patients (4%) developed CNS relapse after HSCT (isolated CNS relapse, n= 8; combined bone marrow and CNS relapse, n= 10). Patients with a previous history of CNS involvement with leukemia had a significantly higher rate for CNS relapse (P= .002), and pretransplantation CNS involvement was the only risk factor for post-transplantation CNS relapse found in this study. We failed to find a significant effect of post-transplantation CNS prophylaxis to prevent relapse after transplantation. Furthermore, no benefit for post-transplantation CNS prophylaxis could be detected when a subgroup analysis of patients with (P= .10) and without previous CNS involvement (P= .52) was performed. Finally, we could not find any significant effect for intensity of the transplantation conditioning regimen on CNS relapse after HSCT. In conclusion, CNS relapse is an uncommon event after HSCT for patients with ALL in CR1 or CR2, but with higher risk among patients with CNS involvement before transplantation. Furthermore, neither the use of post-HSCT CNS prophylaxis nor the intensity of the HSCT conditioning regimen made a significant difference in the rate of post-HSCT CNS relapse.

Original languageEnglish (US)
Pages (from-to)1767-1771
Number of pages5
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Keywords

  • Acute lymphoblastic leukemia
  • Allogeneic hematopoietic stem cell transplantation
  • Central nervous system relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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