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oai:repisalud.isciii.es:20.500.12105/202212024-11-28T23:26:42Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Orti, Guillermo author Sanz, Jaime author Bermudez, Arancha author Caballero, Dolores author Martinez, Carmen author Sierra, Jorge author Cabrera Marin, Jose R author Espigado, Ildefonso author Solano, Carlos author Ferra, Christelle author Garcia-Noblejas, Ana author Jimenez, Santiago author Sampol Mayol, Antonia author Yanez, Lucrecia author Garcia-Gutierrez, Valentin author Jesus Pascual, Maria author Jurado, Manuel author Moraleda, Jose M author Valcarcel, David author Sanz, Miguel A author Carreras, Enric author Duarte, Rafael author 2016-03 Allogeneic stem cell transplantation (allo-HCT) represents the most effective immunotherapy for acute myeloid leukemia (AML) and myeloid malignancies. However, disease relapse remains the most common cause of treatment failure. By performing a second allo-HCT, durable remission can be achieved in some patients. However, a second allo-HCT is of no benefit for the majority of patients, so this approach requires further understanding. We present a retrospective cohort of 116 patients diagnosed with AML, myelodysplastic syndromes, and myeloproliferative disorders who consecutively underwent a second allo-HCT for disease relapse. The median age was 38 years (range, 4 to 69 years). Sixty-three patients were alive at last follow-up. The median follow-up of the whole cohort was 193 days (range, 2 to 6724 days) and the median follow-up of survivors was 1628 days (range, 52 to 5518 days). Overall survival (OS) at 5 years was 32% (SE +/- 4.7%). Multivariate analysis identified active disease status (P < .001) and second allo-HCT < 430 days (the median of the time to second transplantation) after the first transplantation (P < .001) as factors for poor prognosis, whereas the use of an HLA-identical sibling donor for the second allo-HCT was identified as a good prognostic factor (P < .05) for OS. The use of myeloablative conditioning (P = .01), active disease (P = .02), and a donor other than an HLA-identical sibling (others versus HLA-identical siblings) (P = .009) were factors statistically significant for nonrelapse mortality in multivariate analysis. Time to second transplantation was statistically significant (P = .001) in the relapse multivariate analysis, whereas multivariate analysis identified active disease status (P < .001) and time to second transplantation (P < .001) as poor prognosis factors for disease-free survival. This study confirms active disease and early relapse as dismal prognostic factors for a second allo-HCT. Using a different donor at second allo-HCT did not appear to change outcome, but using an HLA-identical sibling donor for a second transplantation appears to be associated with better survival. Further studies are warranted. Orti G, Sanz J, Bermudez A, Caballero D, Martinez C, Sierra J, et al. Outcome of Second Allogeneic Hematopoietic Cell Transplantation after Relapse of Myeloid Malignancies following Allogeneic Hematopoietic Cell Transplantation: A Retrospective Cohort on Behalf of the Grupo Espanol de Trasplante Hematopoyetico. Biol Blood Marrow Transplant. 2016 Mar;22(3):584-8. Epub 2015 Nov 26. 10.1016/j.bbmt.2015.11.012 1523-6536 1083-8791 Biology of Blood and Marrow Transplantation http://hdl.handle.net/20.500.13003/17306 26631751 L607755671 2-s2.0-84954286723 http://hdl.handle.net/20.500.12105/20221 370910200030 Second allogeneic stem cell transplantation Relapse Acute myeloid leukemia Myeloid malignancies Outcome of Second Allogeneic Hematopoietic Cell Transplantation after Relapse of Myeloid Malignancies following Allogeneic Hematopoietic Cell Transplantation: A Retrospective Cohort on Behalf of the Grupo Espanol de Trasplante Hematopoyetico