Second allogeneic stem cell transplantation in patients with acute lymphoblastic leukaemia: a study on behalf of the Acute Leukaemia Working Party of the European Society for Blood and Marrow Transplantation

Arnon Nagler, Myriam Labopin, Bhagirathbhai Dholaria, Jürgen Finke, Arne Brecht, Urs Schanz, Riitta Niittyvuopio, Andreas Neubauer, Martin Bornhäuser, Stella Santarone, Dietrich Beelen, Avichai Shimoni, Wolf Rösler, Sebastian Giebel, Bipin N. Savani, Mohamad Mohty

Research output: Contribution to journalArticlepeer-review

Abstract

Although second allogeneic haematopoietic cell transplantation (allo-HCT2) is a therapeutic option for patients relapsing after first HCT (allo-HCT1), there is limited data on allo-HCT2 in patients with acute lymphoblastic leukaemia (ALL). We retrospectively studied 245 patients receiving allo-HCT2 as a salvage treatment for relapse following allo-HCT1 between the 2000 and 2017. The median age at allo-HCT2 was 34·6 years (range: 18–74). One hundred and one patients (41%) received sibling donor and 144 (59%) unrelated donor allo-HCT2. Acute graft-versus-host disease (GVHD) grade II–IV and III–IV occurred in 33% and 17% of the patients, respectively. The incidence of 2-year total and extensive chronic GVHD was 38% and 19%, respectively. The 2- and 5-year cumulative incidence of non-relapse mortality, relapse incidence, leukaemia-free survival, overall survival and GVHD-free, relapse-free survival (GRFS) were 24% and 26%, 56% and 62%, 20% and 12%, 30% and 14% and 12% & 7%, respectively. In multivariate analysis, factors associated with overall survival were age, time from allo-HCT1 to relapse, conditioning for allo-HCT1, Karnofsky score at allo-HCT2 and donor type for allo-HCT2. In conclusion, outcomes of allo-HCT2 in ALL patients were poor, with only 14% overall survival and 7% GRFS at 5 years with very high relapse incidence.

Original languageEnglish
Pages (from-to)767-776
Number of pages10
JournalBritish Journal of Haematology
Volume186
Issue number5
DOIs
StatePublished - 2019

Keywords

  • acute lymphoblastic leukaemia
  • allogeneic haematopoietic cell transplantation
  • graft-versus-host disease
  • non-relapse mortality
  • relapse

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