title: Outcome of second allogeneic transplants using reduced-intensity conditioning following relapse of haematological malignancy after an initial allogeneic transplant.
abstract: Disease relapse following an allogeneic transplant remains a major cause of treatment failure, often with a poor outcome. Second allogeneic transplant procedures have been associated with high TRM, especially with myeloablative conditioning. We hypothesized that the use of reduced-intensity conditioning (RIC) would decrease the TRM. We performed a retrospective national multicentre analysis of 71 patients receiving a second allogeneic transplant using RIC after disease relapse following an initial allogeneic transplant. The majority of patients had leukaemia/myelodysplasia (MDS) (N=57), nine had lymphoproliferative disorders, two had myeloma and three had myeloproliferative diseases. A total of 25% of patients had unrelated donors. The median follow-up was 906 days from the second allograft. The predicted overall survival (OS) and TRM at 2 years were 28 and 27%, respectively. TRM was significantly lower in those who relapsed late (>11 months) following the first transplant (2 years: 17 vs 38% in early relapses; P=0.03). Two factors were significantly associated with a better survival: late relapse (P=0.014) and chronic GVHD following the second transplant (P=0.014). These data support our hypothesis that the second RIC allograft results in a lower TRM than using MA. A proportion of patients achieved a sustained remission even when relapsing after a previous MA transplant.
authors: Department of Haematology, Royal Marsden Hospital, Institute of Cancer Research, London, UK. bshaw@doctors.org.uk
authors: B E
authors: BE
authors: Shaw
authors: G J
authors: GJ
authors: Mufti
authors: S
authors: S
authors: Mackinnon
authors: J D
authors: JD
authors: Cavenagh
authors: R M
authors: RM
authors: Pearce
authors: K E
authors: KE
authors: Towlson
authors: J F
authors: JF
authors: Apperley
authors: R
authors: R
authors: Chakraverty
authors: C F
authors: CF
authors: Craddock
authors: M A
authors: MA
authors: Kazmi
authors: T J
authors: TJ
authors: Littlewood
authors: D W
authors: DW
authors: Milligan
authors: A
authors: A
authors: Pagliuca
authors: K J
authors: KJ
authors: Thomson
authors: D I
authors: DI
authors: Marks
authors: N H
authors: NH
authors: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult