Second allogeneic stem cell transplantation in myeloid malignancies.
For patients with myeloid malignancies who relapse after allogeneic stem cell transplantation (allo-SCT), one salvage option is a second SCT. We retrospectively analyzed outcomes of the second allo-SCT in 25 patients who received at least 2 allografts from related/unrelated donors due to relapse of acute myeloid leukemia, myelodysplastic syndrome or myelofibrosis after the first SCT. A minority of the acute myeloid leukemia/myelodysplastic syndrome patients had reached complete hematological remission before the second SCT (6/25, 24%). Reduced conditioning strategies were performed in the majority (n = 23). Complete remission was achieved in all 21 cases with available data after the second SCT, but relapse was seen in 11/25 patients (44%). After a median follow-up of 18 months (range 6-47), 8/25 patients (32%) were still alive, and of those, 6 (24%) were in stable remission. In 9 cases mortality was associated to relapse and in 8 cases to transplant-related causes (treatment-related mortality; 8/25, 32%). In conclusion, a second SCT offers the chance of stable remission for some patients relapsing with a myeloid malignancy after a first allo-SCT, although high treatment-related mortality and relapse rates remain a problem. Efforts should concentrate on an optimization of conditioning strategies, immunosuppression and post-transplant surveillance for this specific situation.
Hartwig
Maite
M
Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
Ocheni
Sunday
S
Asenova
Svetlana
S
Wiedemann
Bettina
B
Zabelina
Tatjana
T
Ayuk
Francis
F
Kabisch
Hartmut
H
Erttmann
Rudolf
R
Kröger
Nicolaus
N
Zander
Axel Rolf
AR
Bacher
Ulrike
U
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000601:surgery*; D054429:Leukemia, Myelomonocytic, Juvenile / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000601:surgery*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D011086:Polycythemia / Q000150:complications; D055728:Primary Myelofibrosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult