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Second allogeneic stem cell transplantation in patients with acute lymphoblastic leukaemia: a study on behalf of the Acute Leukaemia Working Party of the European Society for Blood and Marrow Transplantation
Author(s) -
Nagler Ar,
Labopin Myriam,
Dholaria Bhagirathbhai,
Finke Jürgen,
Brecht Arne,
Schanz Urs,
Niittyvuopio Riitta,
Neubauer Andreas,
Bornhäuser Martin,
Santarone Stella,
Beelen Dietrich,
Shimoni Avichai,
Rösler Wolf,
Giebel Sebastian,
Savani Bipin N.,
Mohty Mohamad
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15973
Subject(s) - medicine , cumulative incidence , transplantation , incidence (geometry) , hematopoietic stem cell transplantation , sibling , hematology , gastroenterology , surgery , psychology , developmental psychology , physics , optics
Summary Although second allogeneic haematopoietic cell transplantation (allo‐ HCT 2) is a therapeutic option for patients relapsing after first HCT (allo‐ HCT 1), there is limited data on allo‐ HCT 2 in patients with acute lymphoblastic leukaemia ( ALL ). We retrospectively studied 245 patients receiving allo‐ HCT 2 as a salvage treatment for relapse following allo‐ HCT 1 between the 2000 and 2017. The median age at allo‐ HCT 2 was 34·6 years (range: 18–74). One hundred and one patients (41%) received sibling donor and 144 (59%) unrelated donor allo‐ HCT 2. Acute graft‐versus‐host disease ( GVHD ) grade II – IV and III – IV occurred in 33% and 17% of the patients, respectively. The incidence of 2‐year total and extensive chronic GVHD was 38% and 19%, respectively. The 2‐ and 5‐year cumulative incidence of non‐relapse mortality, relapse incidence, leukaemia‐free survival, overall survival and GVHD ‐free, relapse‐free survival ( GRFS ) were 24% and 26%, 56% and 62%, 20% and 12%, 30% and 14% and 12% & 7%, respectively. In multivariate analysis, factors associated with overall survival were age, time from allo‐ HCT 1 to relapse, conditioning for allo‐ HCT 1, Karnofsky score at allo‐ HCT 2 and donor type for allo‐ HCT 2. In conclusion, outcomes of allo‐ HCT 2 in ALL patients were poor, with only 14% overall survival and 7% GRFS at 5 years with very high relapse incidence.