Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

M. Eapen, S. A. Giralt, M. M. Horowitz, J. P. Klein, J. E. Wagner, M. J. Zhang, M. S. Tallman, D. I. Marks, B. M. Camitta, R. E. Champlin, O. Ringdén, C. N. Bredeson, R. Martino, R. P. Gale, M. S. Cairo, M. R. Litzow, M. deLima

Research output: Contribution to journalArticle

159 Scopus citations

Abstract

Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (≤20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.

Original languageEnglish (US)
Pages (from-to)721-727
Number of pages7
JournalBone Marrow Transplantation
Volume34
Issue number8
DOIs
StatePublished - Oct 1 2004

Keywords

  • Duration of remission
  • Leukemia
  • Matched related donor
  • Reduced-intensity conditioning regimen
  • Second transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Eapen, M., Giralt, S. A., Horowitz, M. M., Klein, J. P., Wagner, J. E., Zhang, M. J., Tallman, M. S., Marks, D. I., Camitta, B. M., Champlin, R. E., Ringdén, O., Bredeson, C. N., Martino, R., Gale, R. P., Cairo, M. S., Litzow, M. R., & deLima, M. (2004). Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplantation, 34(8), 721-727. https://doi.org/10.1038/sj.bmt.1704645