Second HLA-identical sibling transplants for leukemia recurrence.
We analysed data from 114 recipients of HLA-identical sibling transplants who relapsed and received a second transplant between 1978 and 1989. Twenty-nine patients had acute lymphoblastic leukemia, 46 acute myeloid leukemia and 39 chronic myelogenous leukemia. Median (range) interval between first and second transplants was 15 (1-80) months. Following the second transplant, graft failure occurred in 2%, acute graft-versus-host disease (GVHD) in 27% and chronic GVHD in 21% of patients at risk. Risks of interstitial pneumonia and hepatic veno-occlusive disease were higher after the second than the first transplant. Two-year probabilities (95% confidence interval) of treatment-related mortality, relapse and leukemia-free survival were 41% (30-53%), 65% (53-75%) and 21% (14-30%), respectively. Leukemia-free survival was 7% (2-19%) among patients relapsing less than 6 months after their first transplant, with high rates of both relapse, 77% (49-92%), and treatment-related mortality 69% (46-85%). In contrast, leukemia-free survival was 28% (19-41%) in those relapsing more than 6 months after the first transplant; in this group the probability of relapse was 59% (45-72%) and treatment-related mortality 30% (20-43%). Factors correlated with better outcome included a diagnosis of chronic myelogenous leukemia, relapse more than 6 months after the first transplant, acute leukemia in remission prior to the second transplant and good performance status.
Mrsíc
M
M
International Bone Marrow Transplant Registry, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee 53226.
Horowitz
M M
MM
Atkinson
K
K
Biggs
J C
JC
Champlin
R E
RE
Ehninger
G
G
Gajewski
J L
JL
Gale
R P
RP
Herzig
R H
RH
Prentice
H G
HG
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis
D006680:HLA Antigens