title: Unrelated donor stem cell transplantation after autologous transplantation: experience of a single center.
abstract: Patients who do not respond to autologous stem cell transplantation (ASCT) have a poor prognosis. Concerns about toxicity limit the use of unrelated donor stem cell transplantation (UDSCT), but the knowledge about outcome after UDSCT post-ASCT is limited. We carried out a retrospective analysis of the outcome in seven consecutive patients with leukemia (n = 5), myeloma (n = 1) and graft failure (n = 1) who underwent UDSCT after ASCT. Donors were matched for HLA-A, -B and -DR (n = 6) or had one class I antigen mismatch (n = 1). Tissue typing was performed by a high-resolution genomic technique for class II. Median patient age was 34 (11-54) years and time from ASCT to UDSCT was 16 (3-22) months. Patients with malignant diseases were given TBI and a CY preparatory regimen. In addition, all patients received T cell antibodies prior to UDSCT. Grade I acute GVHD developed in all seven patients, but there was no sign of more severe acute GVHD. Two of four evaluable patients developed limited chronic GVHD. Three died of transplant-related toxicity, all due to pulmonary complications. Four patients are alive at 1.1, 1.5, 3.1 and 4.9 years post-UDSCT. A closely matched UDSCT could be considered for selected patients who are not cured by an ASCT.
authors.affiliation: Centre for Allogeneic Stemcell Transplantation, Department of Hematology, Huddinge Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Aschan
authors.forename: M
authors.initials: M
authors.lastname: Remberger
authors.forename: S
authors.initials: S
authors.lastname: Carlens
authors.forename: J
authors.initials: J
authors.lastname: Mattsson
authors.forename: M S
authors.initials: MS
authors.lastname: Dilber
authors.forename: B
authors.initials: B
authors.lastname: Lönnqvist
authors.forename: B
authors.initials: B
authors.lastname: Björkstrand
mesh_terms: D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation