Outcome and prognostic factors among patients who underwent a second transplantation for disease relapse post the first allogeneic cell transplantation

Abstract

The prognosis for disease relapse after first hematopoietic cell transplantation (HCT1) is poor. Here, we present a retrospective multicenter study to evaluate the clinical outcome and the prognostic factors for second hematopoietic cell transplantation (HCT2). The cohort in this study comprised 60 patients diagnosed with acute leukemia, who underwent HCT2 due to hematological relapse after HCT1. The overall survival (OS) at two years, non-relapse mortality (NRM), and relapse mortality (RM) were 30.3%, 40.9%, and 28.8%, respectively. Multivariate analysis for OS identified the use of a donor other than matched-related (MR) donor (hazard ratios [HR] = 4.10, 95% confidence intervals [CI]: 1.72–9.74, p = .001) and high disease status (HR = 2.90, 95% CI: 1.28–6.56, p = .011) as the adverse risk factors for HCT2. On analyzing the combination of factors during HCT1 and HCT2, MR donor, reduced intensity conditioning regimen, and standard status were found to be significant as favorable prognostic factors for OS. Therefore, evaluating these prognostic factors would be helpful in taking decisions regarding post-relapse management.

Keywords:

• Second donor
• hematologic relapse
• acute leukemia

Acknowledgements

Takayoshi Tachibana is the principal investigator and takes primary responsibility for the paper. Takayoshi Tachibana collected and analyzed the data, and wrote the manuscript; Kenji Matsumoto, Masatsugu Tanaka, Maki Hagihara, Kenji Motohashi, Wataru Yamamoto, Satoshi Koyama, Ayumi Numata, Jun Taguchi, Naoto Tomita, and Shin Fujisawa assisted in data collection and manuscript preparation; Masatsugu Tanaka and Hideaki Nakajima supervised the statistical analysis; and Heiwa Kanamori designed and managed this study.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.1080/10428194.2016.1243678.