title: Outcomes of second allogeneic hematopoietic stem cell transplantation for patients with acute lymphoblastic leukemia.
abstract: For patients with ALL who relapse following allo-SCT, only a second SCT provides a realistic chance for long-term disease remission. We retrospectively analyzed the outcomes of 31 patients with relapsed ALL after a prior allo-SCT, who received a second SCT (SCT2) at our center. With a median follow-up of 3 years, 1- and 3-year PFS was 23 and 11% and 1- and 3 year OS rates were 23 and 11%. Twelve patients (39%) were transplanted with active disease, of whom 75% attained a CR. We found a significant relationship between the time to treatment failure following first allograft (SCT1) and PFS following SCT2 (P=0.02, hazard ratio=0.93/month). In summary, a second transplant remains a potential treatment option for achieving response in a highly refractory patient population. While long-term survival is limited, a significant proportion of patients remains disease-free for up to 1 year following SCT2, providing a window of time to administer preventive interventions. Notably, our four long-term survivors received novel therapies with their second transplant underscoring the need for a fundamental change in the methods for SCT2 to improve outcome.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Poon
authors.forename: R
authors.initials: R
authors.lastname: Bassett
authors.forename: G
authors.initials: G
authors.lastname: Rondon
authors.forename: A
authors.initials: A
authors.lastname: Hamdi
authors.forename: M
authors.initials: M
authors.lastname: Qazilbash
authors.forename: C
authors.initials: C
authors.lastname: Hosing
authors.forename: R B
authors.initials: RB
authors.lastname: Jones
authors.forename: E J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: U R
authors.initials: UR
authors.lastname: Popat
authors.forename: Y
authors.initials: Y
authors.lastname: Nieto
authors.forename: L L
authors.initials: LL
authors.lastname: Worth
authors.forename: L
authors.initials: L
authors.lastname: Cooper
authors.forename: M
authors.initials: M
authors.lastname: De Lima
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.forename: P
authors.initials: P
authors.lastname: Kebriaei
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult