Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant

Experimental Hematology & Oncology

Yun Fan¹  Lucy A. Godley²  Andrew S. Artz²  Hongtao Liu²  Justin Kline²  Michael R. Bishop²  Wendy Stock²  Richard A. Larson²  Olatoyosi Odenike²  John M. Cunningham³  James L. LaBelle³  Koen van Besien⁴ 

[1] Department of Hematology, Beijing Hospital;Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medical Center;Department of Pediatrics, University of Chicago Comer Children’s Hospital;Division of Hematology/Oncology, Weill Cornell Medical College;

关键词: Second allogeneic bone marrow transplantation;    T cell depletion;    Non-relapse mortality;   

DOI  :  10.1186/s40164-018-0125-6

来源: DOAJ

【 摘 要 】

Abstract Background Second allogeneic hematopoietic stem cell transplant (HCT) remains as an option for disease relapse after initial HCT. Methods We analyzed retrospectively the outcomes of 65 consecutive patients who underwent a second HCT for disease relapse at the University of Chicago. Univariate and multivariate analysis were conducted, and a scoring system was generated to select the patients who would benefit second HCT. Results All except four patients received T cell depleted (TCD) first HCT. The majority of patients had AML (n = 47) and high risk MDS (n = 5). The median age at second HCT was 45 years (11–73). 13 patients (20%) achieved CR before second HCT. 98% (n = 64) and 72% (n = 47) patients achieved neutrophil and platelet engraftment at a median interval of 10 and 18 days, respectively, following the second HCT. With a median follow up of 23 (5.5–140) months for survivors after second HCT, the estimated 2 years PFS was 17.5% and the 2 years OS was 22.6%. The day 100 cumulative incidence of non-relapse mortality rate was 23.6%, and the cumulative incidence of aGVHD and cGVHD were 16.9% and 7.7% respectively at 1 year after second HCT. In univariate analysis, patients with remission duration after first HCT of > 12 months and those in CR before second HCT had significantly better PFS and OS. A scoring system using disease status before second HCT (CR = 0 vs. non-CR = 1), and remission duration after first HCT (< 6 = 2, 6–12 = 1 and > 12 months = 0) was generated as an approach to classify patients into different risk categories in the purpose to provide guidance to the transplant physician to inform the outcomes to potential patients undergoing 2nd HCT. A score of < 2 (n = 26) identified a group with PFS and OS of 31.6% and 36.2% at 2 years after second HCT. Conclusion In conclusion, second HCT is a viable option for disease relapse after TCD HCT for patients entering second HCT in remission and/or remission duration > 12 months after first HCT with acceptable rates of GVHD and donor engraftment.

【 授权许可】

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