Outcome of Second Allogeneic Hematopoietic Cell Transplantation after Relapse of Myeloid Malignancies following Allogeneic Hematopoietic Cell Transplantation: A Retrospective Cohort on Behalf of the Grupo Espanol de Trasplante Hematopoyetico
Por:
Orti, G, Sanz, J, Bermudez, A, Caballero, D, Martinez, C, Sierra, J, Marin, JRC, Espigado, I, Solano, C, Ferra, C, Garcia-Noblejas, A, Jimenez, S, Sampol, A, Yanez, L, Garcia-Gutierrez, V, Pascual, MJ, Jurado, M, Moraleda, JM, Valcarcel, D, Sanz, MA, Carreras, E, Duarte, RF
Publicada:
1 mar 2016
Resumen:
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. (C) 2016 American Society for Blood and Marrow Transplantation.
Filiaciones:
Orti, G:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Sanz, J:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Bermudez, A:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Caballero, D:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Martinez, C:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Sierra, J:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Marin, JRC:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Espigado, I:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Solano, C:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Ferra, C:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Garcia-Noblejas, A:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Jimenez, S:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Sampol, A:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Yanez, L:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Garcia-Gutierrez, V:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Pascual, MJ:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Jurado, M:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Moraleda, JM:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Valcarcel, D:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Sanz, MA:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Carreras, E:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Josep Carreras Fdn, REDMO, Barcelona, Spain
Leukaemia Res Inst, Barcelona, Spain
Duarte, RF:
GETH, Grp Espanol Trasplante Hematopoyet, Madrid, Spain
Hybrid Gold
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