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How risky is a second allogeneic stem cell transplantation?

There is no consensus on second allogeneic stem cell transplantation (alloSCT) indications in patients with hematologic malignancies relapsing after a first alloSCT. In historic publications, a very high non-relapse mortality (NRM) has been described, arguing against performing a second alloSCT. We...

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Main Authors: Penack, Olaf (Author) , Abouqateb, Mouad (Author) , Peczynski, Christophe (Author) , Boreland, William (Author) , Kröger, Nicolaus (Author) , Zeiser, Robert (Author) , Ciceri, Fabio (Author) , Schroeder, Thomas (Author) , Dreger, Peter (Author) , Passweg, Jakob R. (Author) , Schetelig, Johannes (Author) , Stelljes, Matthias (Author) , Blau, Igor-Wolfgang (Author) , Franke, Georg-Nikolaus (Author) , Riesner, Katarina (Author) , Schoemans, Hélène (Author) , Moiseev, Ivan (Author) , Peric, Zinaida (Author)
Format: Article (Journal)
Language:English
Published: 25 June 2024
In: Leukemia
Year: 2024, Volume: 38, Issue: 8, Pages: 1799-1807
ISSN:1476-5551
DOI:10.1038/s41375-024-02318-3
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1038/s41375-024-02318-3
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Author Notes:Olaf Penack, Mouad Abouqateb, Christophe Peczynski, William Boreland, Nicolaus Kröger, Robert Zeiser, Fabio Ciceri, Thomas Schroeder, Peter Dreger, Jakob Passweg, Johannes Schetelig, Matthias Stelljes, Igor Wolfgang Blau, Georg-Nikolaus Franke, Katarina Riesner, Hélène Schoemans, Ivan Moiseev and Zinaida Peric
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Summary:There is no consensus on second allogeneic stem cell transplantation (alloSCT) indications in patients with hematologic malignancies relapsing after a first alloSCT. In historic publications, a very high non-relapse mortality (NRM) has been described, arguing against performing a second alloSCT. We analysed the outcome of 3356 second alloSCTs performed 2011-21 following a hematologic malignancy relapse. Outcomes at two years after second alloSCT were: NRM 22%, relapse incidence 50%, overall survival 38%, and progression-free survival 28%. Key risk factors for increased NRM were: older age, low performance score, high disease-risk-index, early relapse after the first alloSCT, unrelated/haploidentical donor, and GVHD before second alloSCT. Any type of GVHD after first alloSCT was also important risk factor for acute GVHD and chronic GVHD after second alloSCT. There was a preferential use of a different donor (80%) at second alloSCT from first alloSCT. However, in multivariate analysis, the use of the same alloSCT donor for second alloSCT vs. a different donor was not associated with any of the survival or GVHD endpoints. We show considerably improved outcome as compared to historic reports. These current data support a wider use of second alloSCT and provide risk factors for NRM that need to be considered.
Item Description:Gesehen am 25.02.2025
Physical Description:Online Resource
ISSN:1476-5551
DOI:10.1038/s41375-024-02318-3

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