Haploidentical hematopoietic cell transplantation using in vitro T cell depleted grafts as salvage therapy in patients with disease relapse after prior allogeneic transplantation
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Haploidentical hematopoietic cell transplantation using in vitro T cell depleted grafts as salvage therapy in patients with disease relapse after prior allogeneic transplantation. / Haen, Sebastian P; Groh, Christiane; Schumm, Michael; Backert, Linus; Löffler, Markus W; Federmann, Birgit; Faul, Christoph; Dörfel, Daniela; Vogel, Wichard; Handgretinger, Rupert; Kanz, Lothar; Bethge, Wolfgang A.
in: ANN HEMATOL, Jahrgang 96, Nr. 5, 05.2017, S. 817-827.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Haploidentical hematopoietic cell transplantation using in vitro T cell depleted grafts as salvage therapy in patients with disease relapse after prior allogeneic transplantation
AU - Haen, Sebastian P
AU - Groh, Christiane
AU - Schumm, Michael
AU - Backert, Linus
AU - Löffler, Markus W
AU - Federmann, Birgit
AU - Faul, Christoph
AU - Dörfel, Daniela
AU - Vogel, Wichard
AU - Handgretinger, Rupert
AU - Kanz, Lothar
AU - Bethge, Wolfgang A
PY - 2017/5
Y1 - 2017/5
N2 - Disease relapse after one or more allogeneic hematopoietic cell transplantations (HCT) represents a therapeutic challenge with all options bearing a significant morbidity and mortality. Haploidentical HCT may induce more pronounced anti-leukemic effects and was evaluated at our center in 25 consecutive patients with disease relapse after preceding HCT receiving haploidentical grafts after in vitro T cell depletion. Overall survival at 1 and 2 years was 32 and 14%, respectively. Of note, patients with complete remission (CR) before haploidentical HCT had a very favorable overall survival of 41.7% at 2 years. Cumulative incidence of non-relapse mortality was 36 and 40% at 1 and 2 years, respectively. With a cumulative incidence for relapse of 36 and 45.6% at 1 and 2 years, disease-free survival (DFS) was 28 and 14.4%, respectively. Here also, patients with CR before haploidentical HCT had a favorable DFS of 42% at 2 years. Only very limited acute (11 patients (44%) with a median grade 1) and chronic graft versus host disease (GvHD) (5 patients (11%), limited grade only) was observed. The main complications and causes of death comprised-besides relapse-infections and bleeding complications. Hence, haploidentical HCT can achieve long-term survival comparable to second transplantation with matched or mismatched donors for patients with otherwise deleterious prognosis and should be considered as a treatment option for patients experiencing disease relapse after previous allogeneic HCT.
AB - Disease relapse after one or more allogeneic hematopoietic cell transplantations (HCT) represents a therapeutic challenge with all options bearing a significant morbidity and mortality. Haploidentical HCT may induce more pronounced anti-leukemic effects and was evaluated at our center in 25 consecutive patients with disease relapse after preceding HCT receiving haploidentical grafts after in vitro T cell depletion. Overall survival at 1 and 2 years was 32 and 14%, respectively. Of note, patients with complete remission (CR) before haploidentical HCT had a very favorable overall survival of 41.7% at 2 years. Cumulative incidence of non-relapse mortality was 36 and 40% at 1 and 2 years, respectively. With a cumulative incidence for relapse of 36 and 45.6% at 1 and 2 years, disease-free survival (DFS) was 28 and 14.4%, respectively. Here also, patients with CR before haploidentical HCT had a favorable DFS of 42% at 2 years. Only very limited acute (11 patients (44%) with a median grade 1) and chronic graft versus host disease (GvHD) (5 patients (11%), limited grade only) was observed. The main complications and causes of death comprised-besides relapse-infections and bleeding complications. Hence, haploidentical HCT can achieve long-term survival comparable to second transplantation with matched or mismatched donors for patients with otherwise deleterious prognosis and should be considered as a treatment option for patients experiencing disease relapse after previous allogeneic HCT.
KW - Adolescent
KW - Adult
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Combined Modality Therapy
KW - Female
KW - Graft Survival
KW - Graft vs Host Disease/etiology
KW - Haplotypes
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Hematopoietic Stem Cells/immunology
KW - Humans
KW - Kaplan-Meier Estimate
KW - Leukemia/complications
KW - Lymphocyte Depletion
KW - Male
KW - Middle Aged
KW - Mortality
KW - Recurrence
KW - Retreatment
KW - Salvage Therapy
KW - T-Lymphocytes
KW - Tissue Donors
KW - Transplantation Chimera
KW - Transplantation Conditioning
KW - Transplantation, Homologous
KW - Treatment Outcome
KW - Young Adult
U2 - 10.1007/s00277-017-2941-x
DO - 10.1007/s00277-017-2941-x
M3 - SCORING: Journal article
C2 - 28247058
VL - 96
SP - 817
EP - 827
JO - ANN HEMATOL
JF - ANN HEMATOL
SN - 0939-5555
IS - 5
ER -