Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

M. Eapen; S. A. Giralt; M. M. Horowitz; J. P. Klein; J. E. Wagner; M. J. Zhang; M. S. Tallman; D. I. Marks; B. M. Camitta; R. E. Champlin; O. Ringdén; C. N. Bredeson; R. Martino; R. P. Gale; M. S. Cairo; M. R. Litzow; M. deLima

doi:10.1038/sj.bmt.1704645

Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

M. Eapen^*, S. A. Giralt, M. M. Horowitz, J. P. Klein, J. E. Wagner, M. J. Zhang, M. S. Tallman, D. I. Marks, B. M. Camitta, R. E. Champlin, O. Ringdén, C. N. Bredeson, R. Martino, R. P. Gale, M. S. Cairo, M. R. Litzow, M. deLima

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

201 Scopus 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 (≤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.

Original language	English (US)
Pages (from-to)	721-727
Number of pages	7
Journal	Bone Marrow Transplantation
Volume	34
Issue number	8
DOIs	https://doi.org/10.1038/sj.bmt.1704645
State	Published - 2004
Externally published	Yes

Funding

This work was supported by a Clinical Research Career Development Award from the American Society of Clinical Oncology (ME), Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, the National Heart, Lung and Blood Institute and the Cancer Center, Medical College of Wisconsin.

Keywords

Duration of remission
Leukemia
Matched related donor
Reduced-intensity conditioning regimen
Second transplantation

ASJC Scopus subject areas

Transplantation
Hematology

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10.1038/sj.bmt.1704645

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Eapen, M., Giralt, S. A., Horowitz, M. M., Klein, J. P., Wagner, J. E., Zhang, M. J., Tallman, M. S., Marks, D. I., Camitta, B. M., Champlin, R. E., Ringdén, O., Bredeson, C. N., Martino, R., Gale, R. P., Cairo, M. S., Litzow, M. R., & deLima, M. (2004). Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplantation, 34(8), 721-727. https://doi.org/10.1038/sj.bmt.1704645

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title = "Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant",

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 (≤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.",

keywords = "Duration of remission, Leukemia, Matched related donor, Reduced-intensity conditioning regimen, Second transplantation",

author = "M. Eapen and Giralt, {S. A.} and Horowitz, {M. M.} and Klein, {J. P.} and Wagner, {J. E.} and Zhang, {M. J.} and Tallman, {M. S.} and Marks, {D. I.} and Camitta, {B. M.} and Champlin, {R. E.} and O. Ringd{\'e}n and Bredeson, {C. N.} and R. Martino and Gale, {R. P.} and Cairo, {M. S.} and Litzow, {M. R.} and M. deLima",

note = "Funding Information: This work was supported by a Clinical Research Career Development Award from the American Society of Clinical Oncology (ME), Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, the National Heart, Lung and Blood Institute and the Cancer Center, Medical College of Wisconsin.",

year = "2004",

doi = "10.1038/sj.bmt.1704645",

language = "English (US)",

volume = "34",

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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 2004, 'Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant', Bone Marrow Transplantation, vol. 34, no. 8, pp. 721-727. https://doi.org/10.1038/sj.bmt.1704645

TY - JOUR

T1 - Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

AU - Eapen, M.

AU - Giralt, S. A.

AU - Horowitz, M. M.

AU - Klein, J. P.

AU - Wagner, J. E.

AU - Zhang, M. J.

AU - Tallman, M. S.

AU - Marks, D. I.

AU - Camitta, B. M.

AU - Champlin, R. E.

AU - Ringdén, O.

AU - Bredeson, C. N.

AU - Martino, R.

AU - Gale, R. P.

AU - Cairo, M. S.

AU - Litzow, M. R.

AU - deLima, M.

N1 - Funding Information: This work was supported by a Clinical Research Career Development Award from the American Society of Clinical Oncology (ME), Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, the National Heart, Lung and Blood Institute and the Cancer Center, Medical College of Wisconsin.

PY - 2004

Y1 - 2004

N2 - 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 (≤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.

AB - 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 (≤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.

KW - Duration of remission

KW - Leukemia

KW - Matched related donor

KW - Reduced-intensity conditioning regimen

KW - Second transplantation

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Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant

Abstract

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Keywords

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