Second transplantation outcomes improve for relapsed pediatric AML

Results from a retrospective European Society for Bone Marrow Transplantation (EBMT) registry analysis of 345 pediatric patients receiving second allogeneic hematopoietic stem cell transplantation (HSCT2) for acute myeloid leukemia (AML) relapse post-first transplantation (HSCT1) between 2000 and 2022 were recently published in the British Journal of Haematology by Buchbinder et al.

Key data: Outcomes significantly improved for HSCT2 performed in 2014–2022 compared with in 2000–2013: 3-year leukemia-free survival (34.3% vs 26.3%; hazard ratio [HR], 0.66; p = 0.01), overall survival (42.9% vs 32.8%; HR, 0.60; p = 0.003), and relapse incidence (46.0% vs 54.7%; HR, 0.66; p = 0.038). Relapse >6 months post-HSCT1 and complete remission pre-HSCT2 were associated with better leukemia-free survival (HR, 0.60; p = 0.003), overall survival (HR, 0.64; p = 0.018), and reduced relapse incidence (HR, 0.59; p = 0.008). Non-relapse mortality remained stable at approximately 19%. 

Key learning: HSCT2 outcomes for children with post-transplant relapsed AML have significantly improved over time, with relapse >6 months after HSCT1 and achieving complete remission (CR) before HSCT2 representing key favorable prognostic factors, supporting HSCT2 in carefully selected pediatric patients with relapsed AML.