Second Allograft for Hematologic Relapse of Acute Leukemia After First Allogeneic Stem-Cell Transplantation From Related and Unrelated Donors: The Role of Donor Change

作者：Christopeit Maximilian; Kuss Oliver; Finke Juergen; Bacher Ulrike; Beelen Dietrich Wilhelm; Bornhaeuser Martin; Schwerdtfeger Rainer; Bethge Wolfgang Andreas; Basara Nadezda; Gramatzki Martin; Tischer Johanna; Kolb Hans Jochem; Uharek Lutz; Meyer Ralf G; Bunjes Donald; Scheid Christof; Martin Hans; Niederwieser Dietger; Kroeger Nicolaus; Bertz Hartmut; Schrezenmeier Hubert; Schmid Christoph^*

来源：Journal of Clinical Oncology, 2013, 31(26): 3259-+.

DOI：10.1200/JCO.2012.44.7961

Purpose %26lt;br%26gt;To evaluate the role of a second allogeneic hematopoietic stem-cell transplantation (HSCT2) given for relapsed acute leukemia (AL) after related or unrelated first hematopoietic stem-cell transplantation (HSCT1) and to analyze the role of donor change for HSCT2 in both settings. %26lt;br%26gt;Patients and Methods %26lt;br%26gt;We performed a retrospective registry study on 179 HSCT2s given for relapse after HSCT1 from matched related donors (n = 75) or unrelated donors (n = 104), using identical or alternative donors for HSCT2. Separate analyses were performed according to donor at HSCT1. %26lt;br%26gt;Results %26lt;br%26gt;Independent of donor, 74% of patients achieved complete remission after HSCT2, and half of these patients experienced relapse again. Overall survival (OS) at 2 years was 25% +/- 4% (39% +/- 7% after related HSCT2; 19% +/- 4% after unrelated HSCT2). Long-term survivors were observed even after two unrelated HSCT2s. Multivariate analysis for OS from HSCT2 confirmed established risk factors (remission duration after HSCT1: hazard ratio [HR], 2.37; 95% CI, 1.61 to 3.46; P %26lt; .001; stage at HSCT2: HR, 0.53; 95% CI, 0.34 to 0.83; P = .006). Outcome of HSCT2 was better after related HSCT1 than after unrelated HSCT1 (2-year OS: 37% +/- 6% v 16% +/- 4%, respectively; HR, 0.68; 95% CI, 0.47 to 0.98; P = .042, multivariate Cox regression). After both related and unrelated HSCT1, selecting a new donor for HSCT2 did not result in a relevant improvement in OS compared with HSCT2 from the original donor; however, donor change was not detrimental either. %26lt;br%26gt;Conclusion %26lt;br%26gt;After relapse from allogeneic HSCT1, HSCT2 can induce 2-year OS in approximately 25% of patients. Unrelated HSCT2 is feasible after related and unrelated HSCT1. Donor change for HSCT2 is a valid option. However, a clear advantage in terms of OS could not be demonstrated.

• 出版日期2013-9-10