Second allogeneic bone marrow transplantation in acute leukemia: a multicenter study from the Gruppo Italiano Trapianto Di Midollo Osseo (GITMO)

For patients with ALL who relapse following allo-SCT, only a second SCT provides a realistic chance for long-term disease remission. We retrospectively analyzed the outcomes of 31 patients with relapsed ALL after a prior allo-SCT, who received a second SCT (SCT2) at our center. With a median follow-up of 3 years, 1-and 3-year PFS was 23 and 11% and 1-and 3 year OS rates were 23 and 11%. Twelve patients (39%) were transplanted with active disease, of whom 75% attained a CR. We found a significant relationship between the time to treatment failure following first allograft (SCT1) and PFS following SCT2 (P ¼ 0.02, hazard ratio ¼ 0.93/month). In summary, a second transplant remains a potential treatment option for achieving response in a highly refractory patient population. While long-term survival is limited, a significant proportion of patients remains disease-free for up to 1 year following SCT2, providing a window of time to administer preventive interventions. Notably, our four long-term survivors received novel therapies with their second transplant underscoring the need for a fundamental change in the methods for SCT2 to improve outcome.

Section: Discussionsupporting

confidence: 80%

Outcomes of second allogeneic hematopoietic stem cell transplantation for patients with acute lymphoblastic leukemia

Poon

Bassett

Rondón

et al. 2012

“…Some recent studies suggest that young patient age and better supportive care (in more recent years) are stronger predictors of survival than the interval between the two HCT. 30,31 While the median age of patients in our study was 25 months, their survival may have been more significantly influenced by the year of transplant. Eighty percent of children (four of five) transplanted after 1994 survived compared with only 17% (one of six) receiving HCT before 1994.…”

Section: Discussionmentioning

confidence: 91%

Outcome of second hematopoietic cell transplantation in Hurler syndrome

Grewal

Krivit

DeFor

et al. 2002

“…Our data, as well as other reports, indicate that length of remission after first transplantation is probably the most important variable predicting outcome after second transplant. 1,3,15,[17][18][19][20][21] Relapse, treatment failure and mortality are higher in patients with early relapse. We defined early relapse as occurring within 6 months after first transplant.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,[13][14][15][16][17][18][19][20][21] Thus far, most studies of second transplants for recurrent leukemia are limited by small numbers of patients with heterogeneous prognostic factors. While early relapse after first transplantation and advanced disease status at second transplantation predict poor outcome, data on other factors that may affect outcomes such as conditioning regimen and use of a different donor are few.…”

Section: Discussionmentioning

confidence: 99%

Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

Eapen

Giralt

Horowitz

et al. 2004

204

249

Summary:Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (p20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.