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

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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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Acknowledgements

We thank Anja Junker and Diana Kilian for maintaining our HCT database. We also thank the staff of the Chimerism Lab at the Children’s University Hospital in Tuebingen for providing chimerism data. Furthermore, we acknowledge and appreciate the precious work of all our truly dedicated nurses and staff.

Funding

CS was supported by a Junior Research Group Grant of the Interdisciplinary Centre for Clinical Research (IZKF, 2383-0-0), the Wuerttembergischer Krebspreis and the Clinician Scientist Program of the Faculty of Medicine Tuebingen. DS was supported by a Max Eder Junior Research Group Grant from the Deutsche Krebshilfe, a New Investigator Award of the American Society for Blood and Marrow Transplantation (ASBMT), a Junior Research Group Grant of the Interdisciplinary Centre for Clinical Research (IZKF, 2316-0-0) and the Clinician Scientist Program of the Faculty of Medicine Tuebingen.

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  1. Blood and Marrow Transplantation, Department of Medicine II, University Hospital Tuebingen, Eberhard Karls University, Tuebingen, Germany

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

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  1. Corina Schneidawind
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  2. Volker Hagmaier
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Correspondence to Dominik Schneidawind.

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Schneidawind, C., Hagmaier, V., Faul, C. et al. Second allogeneic hematopoietic cell transplantation enables long-term disease-free survival in relapsed acute leukemia. Ann Hematol 97, 2491–2500 (2018). https://doi.org/10.1007/s00277-018-3454-y

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