Abstract
Relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with poor prognosis. In a subset of patients, durable remissions can be achieved with a second allo-HSCT (allo-HSCT2). However, many patients experience relapse after allo-HSCT2 and they may be considered for a third allo-HSCT (allo-HSCT3). Nevertheless, the benefit of allo-HSCT3 remains unconfirmed. Thus, herein a retrospective analysis of 253 allo-HSCT3s in patients with relapsed/refractory acute leukemia was carried out. In total, 29 (11.5%) survived at a median follow-up of 794 days (range: 87–4 619). The 3-year leukemia-free survival and overall survival (OS) rates were 9.7% and 10.9%, respectively. Patients who maintained remission for ≥2 years after allo-HSCT2 had a significantly better 3-year OS (35.8%) than those who experienced early relapse (<1 year, 7.8%; 1–2 years, 14.0%; P = 0.004). Complete remission at allo-HSCT3, performance status score of 0–1 at allo-HSCT3, grade I acute graft-versus-host disease after allo-HSCT2, and relapse ≥2 years after allo-HSCT2 were associated with better survival in patients who received allo-HSCT3. The prognosis after allo-HSCT3 in patients with relapsed/refractory acute leukemia is generally unfavorable. However, given the lack of alternative treatment options, allo-HSCT3 may be considered in a group of patients.
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We thank all the physicians and the staff at the centers who contributed to the collection of clinical data for the Transplant Registry Unified Management Program of the Japanese Data Center for Hematopoietic Cell Transplantation.
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SK designed the study, organized the project, performed the statistical analysis, and analyzed the data; YKanda, TKonuma, YI, KM, and FK analyzed and interpreted the data; NU, KI, TM, ND, HN, YKatayama, ST, SShiratori, SSaito, TKawakita, JK, TF, and YA gathered and organized the data; SK wrote the first draft and all other authors contributed to the final version.
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Kobayashi, S., Kanda, Y., Konuma, T. et al. Outcomes of third allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute leukemia after a second transplantation. Bone Marrow Transplant 57, 43–50 (2022). https://doi.org/10.1038/s41409-021-01485-6
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DOI: https://doi.org/10.1038/s41409-021-01485-6
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