Faculty Collaboration Database

Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplant 2004 Oct;34(8):721-7

Date

08/24/2004

Pubmed ID

15322568

DOI

10.1038/sj.bmt.1704645

Scopus ID

2-s2.0-6444220659 (requires institutional sign-in at Scopus site)   199 Citations

Abstract

Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (< or =20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.

Author List

Eapen M, Giralt SA, Horowitz MM, Klein JP, Wagner JE, Zhang MJ, Tallman MS, Marks DI, Camitta BM, Champlin RE, Ringdén O, Bredeson CN, Martino R, Gale RP, Cairo MS, Litzow MR, deLima M

Authors

Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Bone Marrow Transplantation
Child
Family
Female
Graft vs Host Disease
Hematopoietic Stem Cells
Histocompatibility Testing
Humans
Leukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Acute
Linear Models
Male
Multivariate Analysis
Neutrophils
Platelet Count
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk
Risk Factors
Sex Factors
Siblings
Stem Cell Transplantation
Time Factors
Transplantation, Homologous
Treatment Outcome