Second allogeneic hematopoietic cell transplantation for relapse after first allografts

Abstract

We analyzed outcomes of 126 patients with hematologic malignancies, who relapsed after first allogeneic hematopoietic cell transplantation (HCT) and received subsequent allografts. In 17 cases, the original donors were utilized, while in 109 cases different donors were identified. The 2-year overall survival (OS), relapse, and non-relapse mortality (NRM) rates were 33%, 42%, and 33%, respectively. Patients with early relapse after first allogeneic HCT (within 100 days vs. 100 days to 12 months vs. >12 months) had higher relapse rates (50% vs. 47% vs. 34%, respectively; p = .01) and worse OS (15% vs. 25% vs. 45%, respectively, p = .005) at 2 years after second allogeneic HCT. In conclusion, second allogeneic HCT should be considered in patients who relapse after first allografts, especially in those who relapse after more than a year. Utilizing a different donor for the second allotransplant including umbilical cord blood or HLA-haploidentical, related donors did not adversely impact outcomes.

Keywords:

• Allogeneic hematopoietic cell transplantation
• post-transplant relapse
• second allotransplant

Acknowledgements

The authors also wish to thank Helen Crawford, Bonnie Larson, and Sue Carbonneau for manuscript preparation; and especially the transplant teams, physicians, nurses, and support personnel for their dedicated care of patients on this study.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2018.1542149

Additional information

Funding

Research reported in this manuscript was supported by the National Cancer Institute under award numbers P01CA018029, P01CA078902, and by the National Heart, Lung, and Blood Institute under award number P01HL122173 from the National Institutes of Health, Bethesda, MD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, which had no involvement in the study design; the collection, analysis and interpretation of data; the writing of the report; nor in the decision to submit the article for publication.