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Outcomes in patients with acute lymphoblastic leukemia who underwent second allogeneic hematopoietic cell transplantation for relapse after first transplantation

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Abstract

Outcomes in patients with acute lymphoblastic leukemia (ALL) who experience relapse after allogeneic hematopoietic cell transplantation (HCT) are unsatisfactory. This study aimed to evaluate the outcomes of patients with ALL who underwent second HCT (HCT2) for relapse after first HCT. It was a single-center retrospective study including adult patients with ALL who underwent HCT2 between 1991 and 2020. The cohort was stratified according to the transplant year, and included 39 patients with a median age of 29 years. A more recent transplant year was associated with achievement of complete remission (CR) and use of reduced-intensity conditioning (RIC), compared with an earlier transplant year. The overall survival (OS) rate and 2-year cumulative incidence of non-relapse mortality (recent vs. earlier) were 55% vs. 8% (P < 0.001) and 26% vs. 75% (P < 0.001), respectively. In multivariate analysis, non-CR (vs. CR; HR 3.6, 95% CI 1.2–11.3, P = 0.025) and myeloablative conditioning (vs. RIC; HR 3.5, 95% CI 1.3–9.4, P = 0.011) were negative prognostic factors for OS. Outcomes of the recent cohort from real-world data are promising, and achieving CR and using the RIC regimen at HCT2 may be an important therapeutic strategy.

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Acknowledgements

None of the authors declare any relevant financial connections.

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Authors and Affiliations

  1. Department of Hematology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan

    Takayoshi Tachibana, Masatsugu Tanaka, Maki Hagihara, Katsumichi Fujimaki & Heiwa Kanamori

  2. Department of Hematology, Fujisawa City Hospital, Fujisawa, Japan

    Katsumichi Fujimaki

  3. Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan

    Maki Hagihara & Hideaki Nakajima

Authors
  1. Takayoshi Tachibana
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  2. Masatsugu Tanaka
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  3. Maki Hagihara
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  4. Katsumichi Fujimaki
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  5. Heiwa Kanamori
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  6. Hideaki Nakajima
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Contributions

TT designed the research, analyzed the data, and wrote the paper. MT supported the data analysis and manuscript preparation. TT, MT, MH, and KF treated the patients as physicians. TM and HK managed the department. HN supervised the study.

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Correspondence to Takayoshi Tachibana.

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Conflict of interest

All authors except for the below have no conflict of interest to declare. TT reports speakers beureus from Otsuka, speakers bureaus from Novartis, speakers bureaus from Pfizer, speakers bureaus from BMS, speakers bureaus from Daiichi Sankyo, and speakers bureaus from Amgen, outside the submitted work.

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Supplementary Information

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12185_2022_3377_MOESM1_ESM.pptx

Supplementary file1 Supplemental Figure 1. CONSORT diagram. Data selection process from the registry of patients with ALL who underwent HCT1 between 1991 and 2020. ALL, acute lymphoblastic leukemia; HCT, allogeneic hematopoietic cell transplantation. Supplemental Figure 2. Subgroup analyses stratified to Ph-ALL and Ph+ALL in patients with ALL who underwent HCT2. Overall survival according to the transplant year in patients with Ph-ALL (A), overall survival according to the transplant year in patients with Ph+ALL (B), disease-free survival according to the transplant year in patients with Ph-ALL (C), and disease-free survival according to the transplant year in patients with Ph+ALL (D). HCT, allogeneic hematopoietic cell transplantation; Ph-, Philadelphia chromosome-negative; Ph+, Philadelphia chromosome-positive. (PPTX 105 KB)

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Tachibana, T., Tanaka, M., Hagihara, M. et al. Outcomes in patients with acute lymphoblastic leukemia who underwent second allogeneic hematopoietic cell transplantation for relapse after first transplantation. Int J Hematol 116, 594–602 (2022). https://doi.org/10.1007/s12185-022-03377-x

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  • DOI: https://doi.org/10.1007/s12185-022-03377-x

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