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Annals of Hematology
Published in: Annals of Hematology 12/2018

01-12-2018 | Original Article

Second allogeneic hematopoietic cell transplantation enables long-term disease-free survival in relapsed acute leukemia

Authors: Corina Schneidawind, Volker Hagmaier, Christoph Faul, Lothar Kanz, Wolfgang Bethge, Dominik Schneidawind

Published in: Annals of Hematology | Issue 12/2018

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Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the treatment of choice for high-risk myeloid and lymphoid leukemias. Relapse after allogeneic HCT is associated with a dismal prognosis and further therapeutic options are limited. One potential curative approach is a second allogeneic HCT. However, there is no consensus about optimal transplant modalities, suitable patients, and entities. We performed a retrospective analysis of our institutional database to evaluate risk factors that influence survival after a second allogeneic HCT for the treatment of relapsed acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). We identified 40 patients (AML, n = 29; ALL, n = 11) that received a second allogeneic HCT at our institution. At time of second HCT, 48% of patients were in complete remission (CR). Current overall survival (OS) was 14/40 patients with a median follow-up of 64 months (range 4–140) of patients alive resulting in a Kaplan-Meier estimated 2-year event-free survival (EFS) and OS of 32%, respectively. Cumulative incidence of non-relapse mortality (NRM) and relapse at 2 years was 31 and 37%, respectively. We identified several independent risk factors influencing OS: > 6 months from first to second transplant (p = 0.02), complete remission prior to transplant (p = 0.003), and the subsequent occurrence of chronic graft-versus-host disease (p = 0.003) were associated with a significantly improved OS. In conclusion, our data suggest that a second allogeneic HCT is a curative treatment option for relapsed acute leukemias in selected patients.
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Metadata
Title
Second allogeneic hematopoietic cell transplantation enables long-term disease-free survival in relapsed acute leukemia
Authors
Corina Schneidawind
Volker Hagmaier
Christoph Faul
Lothar Kanz
Wolfgang Bethge
Dominik Schneidawind
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Annals of Hematology / Issue 12/2018
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-018-3454-y

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