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. 2019 Nov 18;9(12):88.
doi: 10.1038/s41408-019-0251-3.

Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT

Avichai Shimoni  1 , Myriam Labopin  2 , Jürgen Finke  3 , Fabio Ciceri  4 , Eric Deconinck  5 , Nicolaus Kröger  6 , Martin Gramatzki  7 , Matthias Stelljes  8 , Didier Blaise  9 , Friedrich Stoelzel  10 , Patrice Chevallier  11 , Ernst Holler  12 , Nathalie Fegueux  13 , Mohamad Mohty  2   14 , Arnon Nagler  15   2
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Free PMC article

Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT

Avichai Shimoni et al. Blood Cancer J. .
Free PMC article

Abstract

Second allogeneic stem-cell transplantation (SCT2) is a therapeutic option for patients with AML relapsing after a first transplant. Prior studies have shown similar results after SCT2 from the same or different donor; however, there are limited data on second non-T-depleted haplo-identical transplant in this setting. We retrospectively analyzed SCT2 outcomes in 556 patients, median age 46 years, relapsing after first transplant given in CR1. Patients were divided into three groups based on SCT2 donor (donor2): same donor (n = 163, sib/sib-112, UD/UD-51), different matched donor (n = 305, sib/different sib-44, sib/UD-93, UD/different UD-168), or haplo-donor (n = 88, sib/haplo-45, UD/haplo-43). Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively (P = 0.30). Multivariate analysis showed no effect of donor2 type on relapse: hazard ratio (HR) 0.89 (P = 0.57) and 1.11 (P = 0.68) for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 (P = 0.50) and 2.08 (P = 0.03), respectively, and for LFS: HR 1.00 (P = 0.97) and 1.43 (P = 0.07), respectively. In conclusion, SCT2 with the same or different matched donor is associated with similar outcomes in patients with relapsed AML. Non-T-depleted haplo-identical transplant may be associated with higher NRM, similar relapse rate and with no better results in this setting.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Non-relapse mortality (NRM) after second stem cell transplantation from the same donor, a different matched donor, or a haplo-identical donor.
Fig. 2
Fig. 2
Relapse incidence (RI) after second stem cell transplantation from the same donor, a different matched donor, or a haplo-identical donor.
Fig. 3
Fig. 3
Leukemia-free survival (LFS) after second stem cell transplantation from the same donor, a different matched donor, or a haplo-identical donor.
Fig. 4
Fig. 4
Overall Survival (OS) after second stem cell transplantation from the same donor, a different matched donor, or a haplo-identical donor.
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