title: Second hematopoietic SCT for leukemia relapsing after myeloablative T cell-depleted transplants does not prolong survival.
abstract: Patients with leukemia relapsing after allogeneic hematopoietic SCT have a dismal prognosis. A second SCT offers a further opportunity for cure, but has a high rate of treatment failure. To determine the utility of this option, we analyzed 59 consecutive patients relapsing after a myeloablative HLA-matched sibling T cell-depleted (TCD) SCT. Twenty-five patients (13 relapsing within 6 months and 12 relapsing between 6 and 170 months after the first SCT) received a T-replete second SCT. Thirty-eight patients relapsing early had a shorter survival than the 21 patients relapsing later (median 96 vs 298 days, P=0.0002). In patients relapsing early, the second SCT did not improve OS compared with patients receiving non-SCT treatments (median survival 109 vs 80 days, P=0.41). In patients relapsing late, despite an early trend in favor of second SCT, survival was comparable for patients receiving a second SCT compared with non retransplanted patients (median survival 363.5 vs 162 days, P=0.49). Disappointingly, our results do not demonstrate an important survival benefit for a second T-replete allogeneic SCT to treat relapse following a TCD SCT.
authors.affiliation: Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Z A
authors.initials: ZA
authors.lastname: McIver
authors.forename: F
authors.initials: F
authors.lastname: Yin
authors.forename: T
authors.initials: T
authors.lastname: Hughes
authors.forename: M
authors.initials: M
authors.lastname: Battiwalla
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.forename: E
authors.initials: E
authors.lastname: Koklanaris
authors.forename: J
authors.initials: J
authors.lastname: Haggerty
authors.forename: N F
authors.initials: NF
authors.lastname: Hensel
authors.forename: A John
authors.initials: AJ
authors.lastname: Barrett
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000276:immunology*; D006801:Humans; D007938:Leukemia / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate; D013601:T-Lymphocytes / Q000166:cytology / Q000276:immunology*; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult