A Retrospective Review of the Outcome after Second or Subsequent Allogeneic Transplantation

Abstract

The failure of allogeneic stem cell transplant (allo-SCT) is cumbersome. We analyzed our experience in a second allo-SCT. Between the years 1981 and 2007, 144 patients underwent 2 or more allo-SCT. The first to second transplant interval ranged from 18 days to 13.25 years (median 98 days). The most frequent indications for the second SCT were activity of the basic disease (78), rejection (37), and engraftment failure (25). Twenty-nine of the 144 (20%) patients transplanted survived more then a year with treatment-related mortality of 45.5% as the leading cause of death. Interestingly, despite the low rate of graft-versus-host disease (GVHD) prophylaxis used, only 51 and 16 of the patients developed acute and chronic GVHD (aGVHD, cGVHD), respectively. Factors indicating higher likelihood for survival were nonmalignant disease, a nonrelapse indication for the second SCT, full HLA-matching, and the use of reduced-intensity conditioning (RIC). Age at transplantation, time interval between transplants, the development of GVHD, conditioning regimen, GVHD prophylaxis, or graft source were not shown to influence the prognosis. With a median follow-up of 4.5 years, 25 patients (17.2%) are alive, and 18 are disease-free. We conclude that although toxic, a second allo-SCT can lead to long-term survival.

Second haematopoietic SCT using HLA-haploidentical donors in patients with relapse of acute leukaemia after a first allogeneic transplantation

“…The observed 1-year NRM of 36% among our patients was similar to the reported rates (23-45%) for HSCT2 using the same donor 8,26,29 and at the low end of the range of NRM (35-51%) described for HSCT2 involving donor change. 8,26,28,37 With a CR rate of 75% on day +30, early disease control was satisfying.…”

“…12,13 Furthermore, 85% of our patients achieved engraftment, comparable to a 67-97% engraftment rate observed after second HSCT from HLA-matched related or unrelated donors. 10,25,26,28,29 Additionally, sustained full donor chimerism could be established in all patients with continuing CR, as observed by other studies on HSCT2. 10,26 Considering our patients' high disease burden, intensive pretreatment and the frequently short median interval after HSCT1, the overall toxicity was moderate.…”

“…38 Although in general the prognosis of leukaemic relapse after HSCT1 is poor, 39,40 overall outcome in our cohort was encouraging with an OS and RFS of 45% and 33% at 1 year after HSCT2 and compared favourably to earlier studies on HSCT2, demonstrating 1-year OS of 14-20%. 29,31,41 Donor change was performed either not at all 31 or ino 20% of the patients. 29,41 Our results are also comparable to those of the International Bone Marrow Transplant Registry analysis, reporting a 1-year OS of 41% and RFS of 38% for 279 patients relapsing after afirst HLA-matched sibling transplantation, who received HSCT2 from the same HLAmatched donor in 85%.…”

“…29,31,41 Donor change was performed either not at all 31 or ino 20% of the patients. 29,41 Our results are also comparable to those of the International Bone Marrow Transplant Registry analysis, reporting a 1-year OS of 41% and RFS of 38% for 279 patients relapsing after afirst HLA-matched sibling transplantation, who received HSCT2 from the same HLAmatched donor in 85%. 8 However, in contrast to our cohort, approximately 50% of these patients were aged o 30 years and 29% had CML.…”

Outcomes following second allogeneic haematopoietic transplants using fludarabine–melphalan conditioning

“…The role of the conditioning regimen in allo-HCT2 outcomes is difficult to determine as the majority of the survival effect is thought to relate to GVL; however, recent studies have demonstrated that reduced-intensity conditioning (RIC) has improved outcomes compared with myeloablative conditioning (MAC) owing to a reduction in toxicity. 5,6 No series has reported the outcomes in patients conditioned purely with fludarabinemelphalan (Flu-Mel), which is presently the commonest RIC regimen used in Australasia. 7 Here, we report a series of patients receiving allo-HCT2 using Flu-Mel conditioning.…”