PURPOSE: The impact of a second marrow transplant on long-term disease-free survival (DFS) was evaluated for 77 consecutive patients aged 2 to 51 years who relapsed subsequent to allogeneic marrow transplantation after high-dose chemotherapy and total-body irradiation (TBI). PATIENTS AND METHODS: Patients received a second transplant for recurrent chronic myelogenous leukemia (CML) (n = 28), acute myelogenous leukemia (AML) (n = 32), and acute lymphoblastic leukemia (ALL) (n = 15) or lymphoma (n = 2) that used the same marrow donor as the initial transplant. High-dose chemotherapy of busulfan (BU) and cyclophosphamide (CY), or CY, carmustine (BCNU), and etoposide (VP-16), was used as a preparative regimen for the second transplant. Graft-versus-host disease (GVHD) prophylaxis consisted of the following: no prophylaxis (n = 8), T-cell depletion (n = 36), methotrexate (MTX) only (n = 21), cyclosporine (CSP) only (n = 1), MTX and CSP (n = 9), or anti-thymocyte globulin (ATG) and prednisone (n = 2). RESULTS: Engraftment occurred in the 74 assessable patients. Severe veno-occlusive disease (VOD) was the most frequent cause of grades 3 and 4 regimen-related toxicity (RRT); it occurred in 20 patients. The probability of death before day 100 from nonleukemic causes was 36%. The probability of relapse after second transplant was 70%, and the DFS rate was 14% (median DFS, 36 months; range, 22 to 87). The DFS rates for ALL, AML, and CML were 8%, 10%, and 25%, respectively. Multivariate analysis showed that the risk of relapse was inversely associated with acute GVHD (relative risk [RR] of relapse = 0.2; P = .0009). No other factor was associated with relapse. DFS was associated with the presence of acute GVHD (RR of treatment failure = 0.5; P = .0085), and a reduction of DFS was associated with severe VOD (RR = 10.6; P = .0001) and those patients older than 10 years (RR = 2.5; P = .0337). CONCLUSION: These data show that some patients may benefit from a second marrow transplant for recurrent leukemia after an initial marrow transplant. Younger patients and patients with CML especially should be considered as potential candidates for a second transplant.
PURPOSE: The impact of a second marrow transplant on long-term disease-free survival (DFS) was evaluated for 77 consecutive patients aged 2 to 51 years who relapsed subsequent to allogeneic marrow transplantation after high-dose chemotherapy and total-body irradiation (TBI). PATIENTS AND METHODS: Patients received a second transplant for recurrent chronic myelogenous leukemia (CML) (n = 28), acute myelogenous leukemia (AML) (n = 32), and acute lymphoblastic leukemia (ALL) (n = 15) or lymphoma (n = 2) that used the same marrow donor as the initial transplant. High-dose chemotherapy of busulfan (BU) and cyclophosphamide (CY), or CY, carmustine (BCNU), and etoposide (VP-16), was used as a preparative regimen for the second transplant. Graft-versus-host disease (GVHD) prophylaxis consisted of the following: no prophylaxis (n = 8), T-cell depletion (n = 36), methotrexate (MTX) only (n = 21), cyclosporine (CSP) only (n = 1), MTX and CSP (n = 9), or anti-thymocyte globulin (ATG) and prednisone (n = 2). RESULTS: Engraftment occurred in the 74 assessable patients. Severe veno-occlusive disease (VOD) was the most frequent cause of grades 3 and 4 regimen-related toxicity (RRT); it occurred in 20 patients. The probability of death before day 100 from nonleukemic causes was 36%. The probability of relapse after second transplant was 70%, and the DFS rate was 14% (median DFS, 36 months; range, 22 to 87). The DFS rates for ALL, AML, and CML were 8%, 10%, and 25%, respectively. Multivariate analysis showed that the risk of relapse was inversely associated with acute GVHD (relative risk [RR] of relapse = 0.2; P = .0009). No other factor was associated with relapse. DFS was associated with the presence of acute GVHD (RR of treatment failure = 0.5; P = .0085), and a reduction of DFS was associated with severe VOD (RR = 10.6; P = .0001) and those patients older than 10 years (RR = 2.5; P = .0337). CONCLUSION: These data show that some patients may benefit from a second marrow transplant for recurrent leukemia after an initial marrow transplant. Younger patients and patients with CML especially should be considered as potential candidates for a second transplant.
Authors: Ann Dahlberg; Wendy Leisenring; Marie Bleakley; Soheil Meshinchi; K Scott Baker; Corinne Summers; Brandon Hadland; Colleen Delaney; Kanwaldeep Mallhi; Lauri Burroughs; Paul Carpenter; Ann Woolfrey Journal: Bone Marrow Transplant Date: 2019-01-22 Impact factor: 5.483
Authors: Christine N Duncan; Navneet S Majhail; Ruta Brazauskas; Zhiwei Wang; Jean-Yves Cahn; Haydar A Frangoul; Robert J Hayashi; Jack W Hsu; Rammurti T Kamble; Kimberly A Kasow; Nandita Khera; Hillard M Lazarus; Alison W Loren; David I Marks; Richard T Maziarz; Paulette Mehta; Kasiani C Myers; Maxim Norkin; Joseph A Pidala; David L Porter; Vijay Reddy; Wael Saber; Bipin N Savani; Harry C Schouten; Amir Steinberg; Donna A Wall; Anne B Warwick; William A Wood; Lolie C Yu; David A Jacobsohn; Mohamed L Sorror Journal: Biol Blood Marrow Transplant Date: 2014-10-12 Impact factor: 5.742
Authors: R Vrhovac; M Labopin; F Ciceri; J Finke; E Holler; J Tischer; B Lioure; J Gribben; L Kanz; D Blaise; P Dreger; G Held; R Arnold; A Nagler; M Mohty Journal: Bone Marrow Transplant Date: 2015-10-05 Impact factor: 5.483
Authors: G Andreola; M Labopin; D Beelen; P Chevallier; R Tabrizi; A Bosi; M Michallet; S Santarone; G Ehninger; E Polge; D Laszlo; C Schmid; A Nagler; M Mohty Journal: Bone Marrow Transplant Date: 2015-09-21 Impact factor: 5.483
Authors: Aude G Chapuis; Gunnar B Ragnarsson; Hieu N Nguyen; Colette N Chaney; Jeffrey S Pufnock; Thomas M Schmitt; Natalie Duerkopp; Ilana M Roberts; Galina L Pogosov; William Y Ho; Sebastian Ochsenreither; Matthias Wölfl; Merav Bar; Jerald P Radich; Cassian Yee; Philip D Greenberg Journal: Sci Transl Med Date: 2013-02-27 Impact factor: 17.956
Authors: Jason A Coppell; Paul G Richardson; Robert Soiffer; Paul L Martin; Nancy A Kernan; Allen Chen; Eva Guinan; Georgia Vogelsang; Amrita Krishnan; Sergio Giralt; Carolyn Revta; Nicole A Carreau; Massimo Iacobelli; Enric Carreras; Tapani Ruutu; Tiziano Barbui; Joseph H Antin; Dietger Niederwieser Journal: Biol Blood Marrow Transplant Date: 2009-09-18 Impact factor: 5.742