Outcome of Second Allotransplantation for Relapsed Hematologic Malignancies After Stem Cell Transplantation

Allogeneic or autologous stem cell transplantation is a curative therapy for hematologic malignant disease including leukemia, lymphoma, and myeloma. However, the most common cause of failure is disease relapse and then the prognosis is grim and life expectancy is limited. For selected patients in second remission after salvage treatment and performance status is good enough, second allotransplant is another chance to achieve durable survival.

This is a retrospective study in the past 7 years. For relapsed hematolgic malignancy patients after first stem cell transplantation and the ECOG performance status is 0 or 1, we treated with reduced intensity (RIC) or myeloablative conditioning (MAC) regimens directly or after salvage chemotherapy to induce second remission.

We treated 24 patients with salvage allogeneic stem cell transplantation including 23 underwent second and one underwent third transplant between September 2005 and October 2011. The follow-up period is between 10 and 82 months. Patients median age is 40 with range between 23 and 59 with male to female 15/9. Disease entities include 10 AML, 5 ALL, 1 CML BP, 3 NHL, 4 HL, and 1 myeloma. The median duration between first transplant and disease relapse is 13.1 months (range between 2.5 and 52 months). The median interval between first and second transplant is 17.4 months (range between 5 and 64 months). The 5-year overall survival rate is 37% for all 24 patients and 55% for the 10 AML patients.

Second allogeneic stem cell transplant is feasable and durable survival is still promising for selected relapsed patients after first transplantation but the treatment modality is very individualized either RIC or MAC allotransplant according to patients disease entity and disease status.

No relevant conflicts of interest to declare.