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Outcomes of second hematopoietic stem cell transplantation using reduced‐intensity conditioning in an outpatient setting
Author(s) -
JaimePérez José Carlos,
PicónGalindo Ernesto,
HerreraGarza José Luis,
GómezAlmaguer David
Publication year - 2021
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2812
Subject(s) - medicine , cumulative incidence , hematopoietic stem cell transplantation , hazard ratio , transplantation , proportional hazards model , incidence (geometry) , surgery , confidence interval , physics , optics
Relapse and graft failure after autologous (auto) or allogeneic (allo) hematopoietic stem cell transplantation (HSCT) are serious and frequently fatal events. A second HSCT can be a life‐saving alternative, however, information on the results of such intervention in an outpatient setting is limited. Outpatient second hematoprogenitors transplant after reduced‐intensity conditioning (RIC) at a single academic center was analyzed. Twenty‐seven consecutive adults who received an allo‐HSCT after an initial auto‐ or allo‐HSCT from 2006 to 2019 were included. Data were compared using the χ 2 ‐test. Survival analysis using Kaplan–Meier and Cox proportional hazard models was performed; cumulative incidence estimation of transplant‐related mortality (TRM) was assessed. Hodgkin lymphoma was the most frequent diagnosis for the group with a first auto‐HSCT with 5/12 (41.7%) cases, and acute myeloid leukemia for those with a first allo‐HSCT with 6/15 (40%). One‐year overall survival and disease‐free survival (DFS) was 66.7% (95% CI 27.2–88.2) and 59% (95% CI 16–86) for 12 patients with a first auto‐HSCT; and for 15 patients with a first allo‐HSCT, it was 43.3% (95% CI 17.9–66.5) and 36% (95% CI 13.2–59.9), respectively. Eight (29.6%) patients died of TRM and the cumulative incidence of TRM at 1 year was 22% (95% CI 8.6–39.27). Chronic graft‐versus‐host disease and late (>10 months) second transplantation were protective factors for longer survival. Neutropenic fever was more common in the group with a first allo‐HSCT ( p = 0.01). In conclusion, outpatient second allo‐HSCT using RIC after auto‐ or allografting failure or relapse is feasible and offers a reasonable alternative for patients with severe life‐threatening hematological diseases.