Second hematopoietic SCT for leukemia relapsing after myeloablative T cell-depleted transplants does not prolong survival

Z A McIver, F Yin, T Hughes, M Battiwalla, S Ito, E Koklanaris, J Haggerty, N F Hensel, A John Barrett, Z A McIver, F Yin, T Hughes, M Battiwalla, S Ito, E Koklanaris, J Haggerty, N F Hensel, A John Barrett

Abstract

Patients with leukemia relapsing after allogeneic hematopoietic SCT have a dismal prognosis. A second SCT offers a further opportunity for cure, but has a high rate of treatment failure. To determine the utility of this option, we analyzed 59 consecutive patients relapsing after a myeloablative HLA-matched sibling T cell-depleted (TCD) SCT. Twenty-five patients (13 relapsing within 6 months and 12 relapsing between 6 and 170 months after the first SCT) received a T-replete second SCT. Thirty-eight patients relapsing early had a shorter survival than the 21 patients relapsing later (median 96 vs 298 days, P=0.0002). In patients relapsing early, the second SCT did not improve OS compared with patients receiving non-SCT treatments (median survival 109 vs 80 days, P=0.41). In patients relapsing late, despite an early trend in favor of second SCT, survival was comparable for patients receiving a second SCT compared with non retransplanted patients (median survival 363.5 vs 162 days, P=0.49). Disappointingly, our results do not demonstrate an important survival benefit for a second T-replete allogeneic SCT to treat relapse following a TCD SCT.

Trial registration: ClinicalTrials.gov NCT00001623 NCT00001873 NCT00066300 NCT00079391 NCT00353860 NCT00398346 NCT00467961.

Conflict of interest statement

Conflict of interest disclosure: The authors declare no conflicts of interests.

Figures

Figure 1
Figure 1
Overall Survival after Relapse and Type of Hematologic Malignancy
Figure 2
Figure 2
Overall Survival for Early versus Late Relapse after SCT
Figure 3
Figure 3
Overall Survival for Myeloablative (MAC) versus Non-Myeloablative (Non-MAC) Conditioning Regimen of second SCT

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