Outcomes of third allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute leukemia after a second transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 57; no. 1; pp. 43 - 50
• Main Authors: Kobayashi, Shinichi, Kanda, Yoshinobu, Konuma, Takaaki, Inamoto, Yoshihiro, Matsumoto, Kimikazu, Uchida, Naoyuki, Ikegame, Kazuhiro, Miyamoto, Toshihiro, Doki, Noriko, Nakamae, Hirohisa, Katayama, Yuta, Takahashi, Satoshi, Shiratori, Souichi, Saito, Shoji, Kawakita, Toshiro, Kanda, Junya, Fukuda, Takahiro, Atsuta, Yoshiko, Kimura, Fumihiko
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2022; Nature Publishing Group
• Subjects: 631/67/1990; 692/308/174; Acute Disease; Cell Biology; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute - therapy; Medical prognosis; Medicine; Medicine & Public Health; Patients; Prognosis; Public Health; Recurrence; Remission; Remission (Medicine); Retrospective Studies; Stem cell transplantation; Stem Cells; Survival; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-021-01485-6

Relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with poor prognosis. In a subset of patients, durable remissions can be achieved with a second allo-HSCT (allo-HSCT2). However, many patients experience relapse after allo-HSCT2 and they may be considered for a third allo-HSCT (allo-HSCT3). Nevertheless, the benefit of allo-HSCT3 remains unconfirmed. Thus, herein a retrospective analysis of 253 allo-HSCT3s in patients with relapsed/refractory acute leukemia was carried out. In total, 29 (11.5%) survived at a median follow-up of 794 days (range: 87–4 619). The 3-year leukemia-free survival and overall survival (OS) rates were 9.7% and 10.9%, respectively. Patients who maintained remission for ≥2 years after allo-HSCT2 had a significantly better 3-year OS (35.8%) than those who experienced early relapse (<1 year, 7.8%; 1–2 years, 14.0%; P  = 0.004). Complete remission at allo-HSCT3, performance status score of 0–1 at allo-HSCT3, grade I acute graft-versus-host disease after allo-HSCT2, and relapse ≥2 years after allo-HSCT2 were associated with better survival in patients who received allo-HSCT3. The prognosis after allo-HSCT3 in patients with relapsed/refractory acute leukemia is generally unfavorable. However, given the lack of alternative treatment options, allo-HSCT3 may be considered in a group of patients.