title: Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change.
abstract: OBJECTIVE
  To evaluate the role of a second allogeneic hematopoietic stem-cell transplantation (HSCT2) given for relapsed acute leukemia (AL) after related or unrelated first hematopoietic stem-cell transplantation (HSCT1) and to analyze the role of donor change for HSCT2 in both settings.
  
  
  METHODS
  We performed a retrospective registry study on 179 HSCT2s given for relapse after HSCT1 from matched related donors (n = 75) or unrelated donors (n = 104), using identical or alternative donors for HSCT2. Separate analyses were performed according to donor at HSCT1.
  
  
  RESULTS
  Independent of donor, 74% of patients achieved complete remission after HSCT2, and half of these patients experienced relapse again. Overall survival (OS) at 2 years was 25% ± 4% (39% ± 7% after related HSCT2; 19% ± 4% after unrelated HSCT2). Long-term survivors were observed even after two unrelated HSCT2s. Multivariate analysis for OS from HSCT2 confirmed established risk factors (remission duration after HSCT1: hazard ratio [HR], 2.37; 95% CI, 1.61 to 3.46; P < .001; stage at HSCT2: HR, 0.53; 95% CI, 0.34 to 0.83; P = .006). Outcome of HSCT2 was better after related HSCT1 than after unrelated HSCT1 (2-year OS: 37% ± 6% v 16% ± 4%, respectively; HR, 0.68; 95% CI, 0.47 to 0.98; P = .042, multivariate Cox regression). After both related and unrelated HSCT1, selecting a new donor for HSCT2 did not result in a relevant improvement in OS compared with HSCT2 from the original donor; however, donor change was not detrimental either.
  
  
  CONCLUSIONS
  After relapse from allogeneic HSCT1, HSCT2 can induce 2-year OS in approximately 25% of patients. Unrelated HSCT2 is feasible after related and unrelated HSCT1. Donor change for HSCT2 is a valid option. However, a clear advantage in terms of OS could not be demonstrated.
authors.affiliation: Maximilian Christopeit and Oliver Kuss, University of Halle, Halle (Saale); Jürgen Finke and Hartmut Bertz, University Hospital Freiburg, Freiburg; Ulrike Bacher and Nicolaus Kröger, Bone Marrow Transplantation Centre, University Hospital Hamburg-Eppendorf, Hamburg; Ulrike Bacher, Munich Leukaemia Laboratory; Johanna Tischer, Ludwig Maximilian University Hospital; Hans-Jochem Kolb, Technical University Hospital, Munich; Christoph Schmid, Augsburg Medical Hospital, Ludwig Maximilian University of Munich, Augsburg; Dietrich Wilhelm Beelen, University Hospital Essen, Essen; Martin Bornhäuser, University Hospital Dresden, Dresden; Rainer Schwerdtfeger, Deutsche Klinik für Diagnostik, Wiesbaden; Wolfgang Andreas Bethge, University Hospital Tübingen, Tübingen; Nadezda Basara and Dietger Niederwieser, University Hospital Leipzig, Leipzig; Martin Gramatzki, University Hospital Kiel, Kiel; Lutz Uharek, Charité-Campus B. Franklin, University Hospital Berlin, Berlin; Ralf G. Meyer, University Medical Center Mainz, Mainz; Donald Bunjes, University Hospital Ulm; Hubert Schrezenmeier, Deutsches Register für Stammzelltransplantation and Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University of Ulm, Ulm; Christof Scheid, University Hospital Cologne, Cologne; and Hans Martin, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Christopeit
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.forename: Dietrich Wilhelm
authors.initials: DW
authors.lastname: Beelen
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: Wolfgang Andreas
authors.initials: WA
authors.lastname: Bethge
authors.forename: Nadezda
authors.initials: N
authors.lastname: Basara
authors.forename: Martin
authors.initials: M
authors.lastname: Gramatzki
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.forename: Hans-Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Lutz
authors.initials: L
authors.lastname: Uharek
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Meyer
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.forename: Hans
authors.initials: H
authors.lastname: Martin
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Hartmut
authors.initials: H
authors.lastname: Bertz
authors.forename: Hubert
authors.initials: H
authors.lastname: Schrezenmeier
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D055815:Young Adult