Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant.
Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (< or =20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.
Statistical Center, International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI 53226, USA. meapen@mail.mcw.edu
M
M
Eapen
S A
SA
Giralt
M M
MM
Horowitz
J P
JP
Klein
J E
JE
Wagner
M-J
MJ
Zhang
M S
MS
Tallman
D I
DI
Marks
B M
BM
Camitta
R E
RE
Champlin
O
O
Ringdén
C N
CN
Bredeson
R
R
Martino
R P
RP
Gale
M S
MS
Cairo
M R
MR
Litzow
M
M
deLima
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005190:Family; D005260:Female; D006086:Graft vs Host Disease; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009504:Neutrophils / Q000378:metabolism; D010976:Platelet Count; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome