title: Second haematopoietic SCT using HLA-haploidentical donors in patients with relapse of acute leukaemia after a first allogeneic transplantation.
abstract: Haploidentical haematopoietic SCT (HSCT) using T-cell-replete grafts and post-transplant high-dose CY has found increasing acceptance. Our purpose was to evaluate the feasibility and outcome of this strategy as second HSCT incorporating donor change for acute leukaemia relapse after a first allogeneic transplantation. The courses of 20 consecutive adults (median age 37 years, 12 male) with AML (n=14), ALL (n=5) and acute bi-phenotypic leukaemia (n=1) were analysed retrospectively. Conditioning consisted of fludarabine, CY and either melphalan or TBI or tresosulfan+/-etoposide. Engraftment was achieved in 17 (85%), and a second remission was induced in 15 patients (75%) on day +30. The rate of grade II-IV acute GvHD was 35%, while chronic GvHD occurred in five patients. Most commonly observed grade III-IV toxicities were mucositis (30%), hyperbilirubinemia (20%), elevation of transaminases (20%) and creatinine (20%), while invasive fungal infection affected 30%. One-year non-relapse mortality (NRM) was 36%. At a median follow-up of 17 months, estimated 1-year OS was 45%, and 1-year relapse-free survival was 33%. This strategy was feasible and allowed for successful engraftment with a moderate rate of toxicity. Early outcome and NRM are at least comparable with results after a second HSCT from HLA-matched donors without donor change at HSCT2.
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Tischer
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Engel
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Fritsch
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Prevalsek
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hubmann
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schulz
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Zoellner
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Bücklein
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Lippl
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Reibke
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: C T
authors.initials: CT
authors.lastname: Rieger
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Ledderose
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Stemmler
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.affiliation: Department of Internal Medicine II, Klinikum Augsburg, Augsburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hausmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult