Outcome of Second Allogeneic Hematopoietic Cell Transplantation after Relapse of Myeloid Malignancies following Allogeneic Hematopoietic Cell Transplantation

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 so...

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Autores: Ortí, Guillermo|||0000-0002-7889-5807, Sanz, Jaime|||0000-0001-6934-4619, Bermúdez, Arancha, Caballero, Dolores|||0000-0002-9544-9614, Martinez, Carmen, Malouf Sierra, Jorge|||0000-0001-5185-520X, Cabrera Marin, José R., Espigado, Ildefonso|||0000-0002-4043-6613, Solano, Carlos|||0000-0003-3702-0817, Ferrá, Christelle|||0000-0003-4571-5125, García-Noblejas, Ana|||0000-0001-6277-3998, Jimenez, Santiago, Sampol, Antonia|||0000-0001-7465-6203, Yáñez, Lucrecia|||0000-0001-9925-3048, García Gutiérrez, Valentín|||0000-0003-4752-0815, Pascual, Maria Jesus, Jurado, Manuel|||0000-0001-9156-3797, Moraleda, José M., Valcárcel, David|||0000-0002-8747-078X, Sanz, Miguel A.|||0000-0003-1489-1177, Carreras, Enric|||0000-0002-3134-9964, Duarte, Rafael F.
Tipo de recurso: artículo
Fecha de publicación:2016
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:289667
Acceso en línea:https://ddd.uab.cat/record/289667
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2015.11.012
Access Level:acceso abierto
Palabra clave:Acute myeloid leukemia
Myeloid malignancies
Relapse
Second allogeneic stem cell transplantation
Descripción
Sumario: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.

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