title: Haploidentical hematopoietic cell transplantation using in vitro T cell depleted grafts as salvage therapy in patients with disease relapse after prior allogeneic transplantation.
abstract: Disease relapse after one or more allogeneic hematopoietic cell transplantations (HCT) represents a therapeutic challenge with all options bearing a significant morbidity and mortality. Haploidentical HCT may induce more pronounced anti-leukemic effects and was evaluated at our center in 25 consecutive patients with disease relapse after preceding HCT receiving haploidentical grafts after in vitro T cell depletion. Overall survival at 1 and 2 years was 32 and 14%, respectively. Of note, patients with complete remission (CR) before haploidentical HCT had a very favorable overall survival of 41.7% at 2 years. Cumulative incidence of non-relapse mortality was 36 and 40% at 1 and 2 years, respectively. With a cumulative incidence for relapse of 36 and 45.6% at 1 and 2 years, disease-free survival (DFS) was 28 and 14.4%, respectively. Here also, patients with CR before haploidentical HCT had a favorable DFS of 42% at 2 years. Only very limited acute (11 patients (44%) with a median grade 1) and chronic graft versus host disease (GvHD) (5 patients (11%), limited grade only) was observed. The main complications and causes of death comprised-besides relapse-infections and bleeding complications. Hence, haploidentical HCT can achieve long-term survival comparable to second transplantation with matched or mismatched donors for patients with otherwise deleterious prognosis and should be considered as a treatment option for patients experiencing disease relapse after previous allogeneic HCT.
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.|Interfakultäres Institut für Zellbiologie, Abteilung Immunologie, Tübingen, Germany.
authors.forename: Sebastian P
authors.initials: SP
authors.lastname: Haen
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Groh
authors.affiliation: Universitätsklinik für Kinder- und Jugendmedizin, Abteilung I für Allgemeine Pädiatrie, Hämatologie und Onkologie, Tübingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schumm
authors.affiliation: Interfakultäres Institut für Zellbiologie, Abteilung Immunologie, Tübingen, Germany.|Eberhard Karls-Universität Tübingen, Applied Bioinformatics Group, Tübingen, Germany.
authors.forename: Linus
authors.initials: L
authors.lastname: Backert
authors.affiliation: Interfakultäres Institut für Zellbiologie, Abteilung Immunologie, Tübingen, Germany.|Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Löffler
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.|Institut für Allgemeine Pathologie und Pathologische Anatomie, Tübingen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Federmann
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Faul
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dörfel
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.
authors.forename: Wichard
authors.initials: W
authors.lastname: Vogel
authors.affiliation: Universitätsklinik für Kinder- und Jugendmedizin, Abteilung I für Allgemeine Pädiatrie, Hämatologie und Onkologie, Tübingen, Germany.
authors.forename: Rupert
authors.initials: R
authors.lastname: Handgretinger
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.affiliation: Medizinische Klinik II für Onkologie, Hämatologie, Immunologie, Rheumatologie und Pulmologie, Universitätsklinikum Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany. wolfgang.bethge@med.uni-tuebingen.de.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Bethge
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006412:Hematopoietic Stem Cells / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012008:Recurrence; D019233:Retreatment; D016879:Salvage Therapy; D013601:T-Lymphocytes; D014019:Tissue Donors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Graft versus host disease; Haploidentical hematopoietic cell transplantation; Relapse; Salvage therapy