| Affiliation: | 1. Chaim Sheba Medical Centre, Tel Aviv University, Tel-Hashomer, Israel EBMT ALWP office, Saint Antoine Hospital, Paris, France;2. Department of Haematology and EBMT Paris study office/CEREST-TC, Saint Antoine Hospital, Paris, France;3. Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA;4. Department of Medicine–Haematology Oncology, University of Freiburg, Freiburg, Germany;5. Deutsche Klinik fuer Diagnostik, KMT Zentrum, Wiesbaden, Germany;6. Clinic of Haematology, University Hospital, Zurich, Switzerland;7. Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Centre, Helsinki, Finland;8. Philipps Universitaet Marburg, University Hospital Giessen and Marburg, Marburg, Germany;9. Medizinische Klinik und Poliklinik I, Universitaetsklinikum Dresden, Dresden, Germany;10. Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Civile, Pescara, Italy;11. Department of Bone Marrow Transplantation, University Hospital, Essen, Germany;12. Department of Bone Marrow Transplantation, Chaim Sheba Medical Centre Chaim Sheba Medical Centre, Tel Hashomer, Israel;13. Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany;14. Department of Bone Marrow Transplantation and Oncohaematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland;15. AService d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorobonne University, INSERM UMR 938 and Université Pierre et Marie Curie, Paris, France |
| Abstract: | Although second allogeneic haematopoietic cell transplantation (allo-HCT2) is a therapeutic option for patients relapsing after first HCT (allo-HCT1), there is limited data on allo-HCT2 in patients with acute lymphoblastic leukaemia (ALL). We retrospectively studied 245 patients receiving allo-HCT2 as a salvage treatment for relapse following allo-HCT1 between the 2000 and 2017. The median age at allo-HCT2 was 34·6 years (range: 18–74). One hundred and one patients (41%) received sibling donor and 144 (59%) unrelated donor allo-HCT2. Acute graft-versus-host disease (GVHD) grade II–IV and III–IV occurred in 33% and 17% of the patients, respectively. The incidence of 2-year total and extensive chronic GVHD was 38% and 19%, respectively. The 2- and 5-year cumulative incidence of non-relapse mortality, relapse incidence, leukaemia-free survival, overall survival and GVHD-free, relapse-free survival (GRFS) were 24% and 26%, 56% and 62%, 20% and 12%, 30% and 14% and 12% & 7%, respectively. In multivariate analysis, factors associated with overall survival were age, time from allo-HCT1 to relapse, conditioning for allo-HCT1, Karnofsky score at allo-HCT2 and donor type for allo-HCT2. In conclusion, outcomes of allo-HCT2 in ALL patients were poor, with only 14% overall survival and 7% GRFS at 5 years with very high relapse incidence. |
