Outcome of Second Allogeneic Hematopoietic Cell Transplantation after Relapse of Myeloid Malignancies following Allogeneic Hematopoietic Cell Transplantation : A Retrospective Cohort on Behalf of the Grupo Español de Trasplante Hematopoyetico
Orti, Guillermo (Grupo Español de Trasplante Hematopoyetico)
Sanz, Jaime (Grupo Español de Trasplante Hematopoyetico)
Bermúdez, Arancha (Grupo Español de Trasplante Hematopoyetico)
Caballero, Dolores (Grupo Español de Trasplante Hematopoyetico)
Martinez, Carmen (Grupo Español de Trasplante Hematopoyetico)
Malouf Sierra, Jorge 1971- (Institut d'Investigació Biomèdica Sant Pau)
Cabrera Marin, José R. (Grupo Español de Trasplante Hematopoyetico)
Espigado, Ildefonso (Grupo Español de Trasplante Hematopoyetico)
Solano, Carlos (Grupo Español de Trasplante Hematopoyetico)
Ferrà, Christelle (Grupo Español de Trasplante Hematopoyetico)
García-Noblejas, Ana (Grupo Español de Trasplante Hematopoyetico)
Jimenez, Santiago (Grupo Español de Trasplante Hematopoyetico)
Sampol, Antonia (Grupo Español de Trasplante Hematopoyetico)
Yañez, Lucrecia (Grupo Español de Trasplante Hematopoyetico)
García-Gutiérrez, Valentin (Grupo Español de Trasplante Hematopoyetico)
Pascual, Maria Jesus (Grupo Español de Trasplante Hematopoyetico)
Jurado, Manuel (Grupo Español de Trasplante Hematopoyetico)
Moraleda, José M. (Grupo Español de Trasplante Hematopoyetico)
Valcarcel, David (Grupo Español de Trasplante Hematopoyetico)
Sanz, Miguel A. (Grupo Español de Trasplante Hematopoyetico)
Carreras, Enric (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Duarte, Rafael F. (Grupo Español de Trasplante Hematopoyetico)
Universitat Autònoma de Barcelona

Date:	2016
Abstract:	Allogeneic stem cell transplantation (allo-HCT) represents the most effective immunotherapy for acute myeloid leukemia (AML) and myeloid malignancies. However, disease relapse remains the most common cause of treatment failure. By performing a second allo-HCT, durable remission can be achieved in some patients. However, a second allo-HCT is of no benefit for the majority of patients, so this approach requires further understanding. We present a retrospective cohort of 116 patients diagnosed with AML, myelodysplastic syndromes, and myeloproliferative disorders who consecutively underwent a second allo-HCT for disease relapse. The median age was 38 years (range, 4 to 69 years). Sixty-three patients were alive at last follow-up. The median follow-up of the whole cohort was 193 days (range, 2 to 6724 days) and the median follow-up of survivors was 1628 days (range, 52 to 5518 days). Overall survival (OS) at 5 years was 32% (SE ± 4. 7%). Multivariate analysis identified active disease status (P <. 001) and second allo-HCT < 430 days (the median of the time to second transplantation) after the first transplantation (P <. 001) as factors for poor prognosis, whereas the use of an HLA-identical sibling donor for the second allo-HCT was identified as a good prognostic factor (P <. 05) for OS. The use of myeloablative conditioning (P =. 01), active disease (P =. 02), and a donor other than an HLA-identical sibling (others versus HLA-identical siblings) (P =. 009) were factors statistically significant for nonrelapse mortality in multivariate analysis. Time to second transplantation was statistically significant (P =. 001) in the relapse multivariate analysis, whereas multivariate analysis identified active disease status (P <. 001) and time to second transplantation (P <. 001) as poor prognosis factors for disease-free survival. This study confirms active disease and early relapse as dismal prognostic factors for a second allo-HCT. Using a different donor at second allo-HCT did not appear to change outcome, but using an HLA-identical sibling donor for a second transplantation appears to be associated with better survival. Further studies are warranted.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute myeloid leukemia ; Myeloid malignancies ; Relapse ; Second allogeneic stem cell transplantation
Published in:	Biology of blood and marrow transplantation, Vol. 22 Núm. 3 (january 2016) , p. 584-588, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2015.11.012
PMID: 26631751

5 p, 178.9 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Josep Carreras Leukaemia Research Institute
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles