Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change
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Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change. / Christopeit, Maximilian; Kuss, Oliver; Finke, Jürgen; Bacher, Ulrike; Beelen, Dietrich Wilhelm; Bornhäuser, Martin; Schwerdtfeger, Rainer; Bethge, Wolfgang Andreas; Basara, Nadezda; Gramatzki, Martin; Tischer, Johanna; Kolb, Hans-Jochem; Uharek, Lutz; Meyer, Ralf G; Bunjes, Donald; Scheid, Christof; Martin, Hans; Niederwieser, Dietger; Kröger, Nicolaus; Bertz, Hartmut; Schrezenmeier, Hubert; Schmid, Christoph.
In: J CLIN ONCOL, Vol. 31, No. 26, 10.09.2013, p. 3259-71.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change
AU - Christopeit, Maximilian
AU - Kuss, Oliver
AU - Finke, Jürgen
AU - Bacher, Ulrike
AU - Beelen, Dietrich Wilhelm
AU - Bornhäuser, Martin
AU - Schwerdtfeger, Rainer
AU - Bethge, Wolfgang Andreas
AU - Basara, Nadezda
AU - Gramatzki, Martin
AU - Tischer, Johanna
AU - Kolb, Hans-Jochem
AU - Uharek, Lutz
AU - Meyer, Ralf G
AU - Bunjes, Donald
AU - Scheid, Christof
AU - Martin, Hans
AU - Niederwieser, Dietger
AU - Kröger, Nicolaus
AU - Bertz, Hartmut
AU - Schrezenmeier, Hubert
AU - Schmid, Christoph
PY - 2013/9/10
Y1 - 2013/9/10
N2 - 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.
AB - 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.
KW - Acute Disease
KW - Adolescent
KW - Adult
KW - Aged
KW - Female
KW - Follow-Up Studies
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Leukemia
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local
KW - Neoplasm Staging
KW - Neoplasm, Residual
KW - Prognosis
KW - Remission Induction
KW - Retrospective Studies
KW - Survival Rate
KW - Tissue Donors
KW - Transplantation, Homologous
KW - Unrelated Donors
KW - Young Adult
U2 - 10.1200/JCO.2012.44.7961
DO - 10.1200/JCO.2012.44.7961
M3 - SCORING: Journal article
C2 - 23918951
VL - 31
SP - 3259
EP - 3271
JO - J CLIN ONCOL
JF - J CLIN ONCOL
SN - 0732-183X
IS - 26
ER -
