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

Shinichi Kobayashi, Yoshinobu Kanda, Takaaki Konuma, Yoshihiro Inamoto, Kimikazu Matsumoto, Naoyuki Uchida, Kazuhiro Ikegame, Toshihiro Miyamoto, Noriko Doki, Hirohisa Nakamae, Yuta Katayama, Satoshi Takahashi, Souichi Shiratori, Shoji Saito, Toshiro Kawakita, Junya Kanda, Takahiro Fukuda, Yoshiko Atsuta, Fumihiko Kimura

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalBone Marrow Transplantation
Volume57
Issue number1
DOIs
Publication statusPublished - 01-2022
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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