Second Allograft for Hematologic Relapse of Acute Leukemia After First Allogeneic Stem-Cell Transplantation From Related and Unrelated Donors: The Role of Donor Change

Abstract

After relapse from allogeneic HSCT1, HSCT2 can induce 2-year OS in approximately 25% of patients. Unrelated HSCT2 is feasible after related and unrelated HSCT1. Donor change for HSCT2 is a valid option. However, a clear advantage in terms of OS could not be demonstrated.

Second allo-SCT in patients with lymphoma relapse after a first allogeneic transplantation. A retrospective study of the EBMT Lymphoma Working Party

“…In contrast, selecting a donor for alloHSCT_2 different from that used for alloHSCT_1 had no significant impact on OS, PFS or RI in the patient sample studied here. This finding is also in keeping with observations made in leukemia studies, 11,12 with the exception that in the German Cooperative Transplant Study Group analysis a small group of second transplants from an alternative sibling donor yielded significantly better results than those achieved with repeat use of the first sibling or unrelated donor or an alternative unrelated donor. 12 Notably, although this subset analysis was limited by small numbers, patients with mantle cell lymphoma and diffuse large B-cell lymphoma did not benefit from a second alloHSCT, whereas long-term PFS after alloHSCT occurred in a substantial proportion of patients with HL, TCL and, in particular, indolent lymphoma.…”

“…This finding is also in keeping with observations made in leukemia studies, 11,12 with the exception that in the German Cooperative Transplant Study Group analysis a small group of second transplants from an alternative sibling donor yielded significantly better results than those achieved with repeat use of the first sibling or unrelated donor or an alternative unrelated donor. 12 Notably, although this subset analysis was limited by small numbers, patients with mantle cell lymphoma and diffuse large B-cell lymphoma did not benefit from a second alloHSCT, whereas long-term PFS after alloHSCT occurred in a substantial proportion of patients with HL, TCL and, in particular, indolent lymphoma. Although the 20-30% PFS plateaus observed seem to be inferior to 3-year PFS rates ranging from 25 to 60% in registry studies on first allotransplants in HL, TCL and follicular lymphoma, 19,20,[25][26][27] this outcome is in line with circumstantial evidence suggesting that these three entities are more susceptible to GVL than aggressive B-cell lymphoma.…”

“…With a 3-year OS probability of 29%, survival resembles that reported for second allotransplants for relapsed myeloid malignancies, ranging from 21% after 2 years to 32% after 5 years. [10][11][12][13][14]18 Second allogeneic transplantation for lymphoma relapse K Horstmann et al Importantly, the 3-year NRM of 23% observed here compares well with NRM figures observed in registry studies on first allotransplants in lymphoma, 2,[19][20][21][22][23][24][25] implying that a repeat allotransplant does not seem to be associated with an unacceptable increase in NRM.…”

“…Similar to leukemia, [10][11][12][13][14]18 the most important risk factors adversely affecting OS after alloHSCT_2 for lymphoma were remission status at second transplant and interval between alloHSCT_1 and alloHSCT_2 (as a surrogate marker for remission duration after alloHSCT_1). In contrast, selecting a donor for alloHSCT_2 different from that used for alloHSCT_1 had no significant impact on OS, PFS or RI in the patient sample studied here.…”

“…[10][11][12][13][14] In contrast, information on alloHSCT_2 in patients with lymphoma is sparse. The purpose of the present registry study was to assess the outcome of second allogeneic transplants performed for lymphoma relapse after a alloHSCT_1.…”