Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: The role of donor change

Maximilian Christopeit, Oliver Kuss, Jürgen Finke, Ulrike Bacher, Dietrich Wilhelm Beelen, Martin Bornhäuser, Rainer Schwerdtfeger, Wolfgang Andreas Bethge, Nadezda Basara, Martin Gramatzki, Johanna Tischer, Hans Jochem Kolb, Lutz Uharek, Ralf G. Meyer, Donald Bunjes, Christof Scheid, Hans Martin, Dietger Niederwieser, Nicolaus Kröger, Hartmut BertzHubert Schrezenmeier, Christoph Schmid

Research output: Contribution to journalArticlepeer-review

131 Scopus citations

Abstract

Purpose: To evaluate the role of a second allogeneic hematopoietic stem-cell transplantation (HSCT2) given for relapsed acute leukemia (AL) after related or unrelated first hematopoietic stem-cell transplantation (HSCT1) and to analyze the role of donor change for HSCT2 in both settings. Patients and Methods: We performed a retrospective registry study on 179 HSCT2s given for relapse after HSCT1 from matched related donors (n = 75) or unrelated donors (n = 104), using identical or alternative donors for HSCT2. Separate analyses were performed according to donor at HSCT1. Results: Independent of donor, 74% of patients achieved complete remission after HSCT2, and half of these patients experienced relapse again. Overall survival (OS) at 2 years was 25% ± 4% (39% ± 7% after related HSCT2; 19% ± 4% after unrelated HSCT2). Long-term survivors were observed even after two unrelated HSCT2s. Multivariate analysis for OS from HSCT2 confirmed established risk factors (remission duration after HSCT1: hazard ratio [HR], 2.37; 95% CI, 1.61 to 3.46; P < .001; stage at HSCT2: HR, 0.53; 95% CI, 0.34 to 0.83; P = .006). Outcome of HSCT2 was better after related HSCT1 than after unrelated HSCT1 (2-year OS: 37% ± 6% v 16% ± 4%, respectively; HR, 0.68; 95% CI, 0.47 to 0.98; P = .042, multivariate Cox regression). After both related and unrelated HSCT1, selecting a new donor for HSCT2 did not result in a relevant improvement in OS compared with HSCT2 from the original donor; however, donor change was not detrimental either. Conclusion: After relapse from allogeneic HSCT1, HSCT2 can induce 2-year OS in approximately 25% of patients. Unrelated HSCT2 is feasible after related and unrelated HSCT1. Donor change for HSCT2 is a valid option. However, a clear advantage in terms of OS could not be demonstrated.

Original languageEnglish
Pages (from-to)3259-3271
Number of pages13
JournalJournal of Clinical Oncology
Volume31
Issue number26
DOIs
StatePublished - 10 Sep 2013
Externally publishedYes

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