ASH evidence-based guidelines: is there a role for second allogeneic transplant after relapse?
A 35-year-old male with a FLT3(+) AML underwent allogeneic peripheral blood stem cell transplant using a myeloablative non-total body irradiation (TBI) conditioning regimen from his HLA-matched sibling donor. Following transplantation, he developed grade II acute graft-versus-host disease (GVHD) that resolved with increasing immunosuppression. The medications were subsequently discontinued, and he did not develop any evidence of chronic GVHD. Eighteen months after transplant, while off all immunosuppression, he developed fatigue and a blood count showed circulating blasts consistent with relapse of his disease. Among the various therapeutic questions is whether there is a role for a second allogeneic transplant to treat his disease and if so, at what time, with what conditioning, and with which type of donor.
Thakar
Monica S
MS
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Forman
Stephen J
SJ
D000208:Acute Disease; D000328:Adult; D019317:Evidence-Based Medicine; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000601:surgery*; D008297:Male; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012086:Reoperation; D014019:Tissue Donors; D014184:Transplantation, Homologous; D051941:fms-Like Tyrosine Kinase 3 / Q000032:analysis
D007166:Immunosuppressive Agents; C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3