Abstract
All patients receiving autografts for acute leukaemia in remission between 1 January 1981 and 31 December 1996 and reported to the European Group for Blood and Marrow Transplantation and had a relapse, were included. The patients underwent an allograft (n = 90, group A), were treated with chemotherapy (n = 2584, group B) or received a second autograft (n = 74, group C). The 2-year survival after relapse was 32 ± 5%, 11 ± 1% and 42 ± 6% in groups A, B and C, respectively. In group A, those with an HLA-A, -B and -DR compatible related or unrelated donor had a 2-year survival of 37 ± 7% compared to 13 ± 8% for those receiving a graft from an HLA mismatched donor (n = 20). the following factors were associated with better survival in multivariate analyses: an interval from first autograft to relapse >5 months (P < 0.00001), a first autograft performed later than 1991 (P < 0.00001), patient age below 26 years (median, P < 0.002), group b vs HLA mismatches from group A (P = 0.002), group C vs group B (P < 0.005), patients who were not treated with total body irradiation at first autograft (P < 0.02) and patients in first remission at first autograft (P = 0.02). To conclude, the poor outcome in these patients was improved if a second autograft was feasible (P < 0.005), or if an hla-matched allograft was performed (ns). Bone Marrow Transplantation (2000) 25, 1053–1058.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Burnett A, Eden O . The treatment of acute leukemia Lancet 1997 349: 270–275
Gorin NC . Autologous stem cell transplantation in acute myelocytic leukemia Blood 1998 92: 1073–1090
Rowe JM, Ciobanu N, Ascensao J et al. Recommended guidelines for the management of autologous and allogeneic bone marrow transplantation Ann Intern Med 1994 120: 143–158
Schmitz N, Gratwohl A, Goldman JM, for Accreditation Sub-Committee of the European Group for Blood and Marrow Transplantation (EBMT) . Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders. Current practice in Europe in 1996 and proposals for an operational classification Bone Marrow Transplant 1996 17: 471–477
Burnett AK, Goldstone AH, Stevens RM et al. Randomised comparison of addition of autologous bone marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial. UK Medical Research Council Adult and Children's Leukaemia Working Parties Lancet 1998 351: 700–708
Hermans J, Suciu S, Stijnen T et al. Treatment of acute myelogenous leukaemia: an EBMT-EORTC retrospective analysis of chemotherapy versus allogeneic or autologous bone marrow transplantation Eur J Oncol 1989 25: 545–550
Gorin NC, Labopin M, Fouillard L et al. Retrospective evaluation of autologous bone marrow transplantation vs allogeneic bone marrow transplantation from an HLA-identical related donor in acute myelocytic leukemia. A study of the European Cooperative Group for Blood and Marrow Transplantation (EBMT) Bone Marrow Transplant 1996 18: 111–117
Zittoun R, Mandelli F, Willemze R et al,. for the European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne Dell'Adulto (GIMENA) Leukemia Cooperative Groups Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukaemia New Engl J Med 1995 332: 217–223
Reiffers J, Stoppa AM, Attal M et al., for the EBMT Group Allogeneic vs autologous stem cell transplantation vs chemotherapy in patients with acute myeloid leukemia in first remission: the BGMT 87 study Leukemia 1996 10: 1874–1882
Ringdén O, Labopin M, Gluckman E et al, . for the Acute Leukemia Working Party of the European Cooperative Group for Blood and Marrow Transplantation (EBMT) and the International Marrow Unrelated Search and Transplant (IMUST) study Donor search or autografting in patients with acute leukaemia who lack an HLA-identical sibling? A matched-pair analysis Bone Marrow Transplant 1997 19: 963–968
Odom L, August CS, Githens JH et al. Remission of relapsed leukemia during a graft-versus-host reaction A graft-versus-leukemia reaction in man? Lancet 1978 2: 537–540
Weiden PL, Fluornoy N, Thomas ED et al. Anti-leukemic effect of graft-versus-host disease in human recipients of allogeneic marrow grafts New Engl J Med 1979 300: 1068–1073
Horowitz MM, Gale RP, Sondel PM et al. Graft-versus-leukemia reactions after bone marrow transplantation Blood 1990 75: 555–562
Ringdén O, Labopin M, Gluckman E et al,. for the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Graft-versus-leukemia effect in allogeneic marrow transplant recipients with acute leukemia is maintained using cyclosporin A combined with methotrexate as prophylaxis Bone Marrow Transplant 1996 18: 921–929
Brenner MK, Rill DR, Moen RC et al. Gene-marking to trace origin of relapse after autologous bone-marrow transplantation Lancet 1993 341: 85–86
Kaplan EL, Meier P . Nonparametric estimation from incomplete observations J Am Stat Assoc 1958 53: 457–481
Cox DR . Regression models and life-tables JR Stat Soc (Series B) 1972 34: 187–220
Vose JM, Armitage JO . Clinical applications of hematopoietic growth factors J Clin Oncol 1995 13: 1023–1035
Welte K, Gabrilove J, Bronchud MH et al. Filgrastim(r-metHugG-CSF): the first 10 years Blood 1996 88: 1907–1929
Barrett AJ, Horowitz MM, Gale RP et al. Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival Blood 1989 74: 862–871
Ringdén O, Remberger M, Persson U et al. Similar incidence of graft-versus-host disease using HLA-A, -B and -DR identical unrelated bone marrow donors as with HLA-identical siblings Bone Marrow Transplant 1995 15: 619–625
Petersdorf EW, Longton GM, Anasetti C et al. The significance of HLA-DRB1 matching on clinical outcome after HLA-A, -B, -DR identical unrelated donor marrow transplantation Blood 1995 86: 1606–1613
Ringdén O, Labopin M, Frassoni F et al, . for the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT) Allogeneic bone marrow transplantation or second autograft in patients with acute leukemia who relapse after an autograft Bone Marrow Transplant 1999 24: 389–396
Oakhill A, Pamphilon D, Potter M et al. Unrelated donor bone marrow transplantation for children with relapsed acute lymphoblastic leukaemia in second complete remission Br J Haematol 1996 94: 574–578
Acknowledgements
This work was supported by EBMT Funds, convention 6113, from the Association por la Recherche, Contre la Cancer (ARC), Villejuif, France, and grant from Etablissement Francaise des Graftes (EFG). O Ringdén was supported by grants from the Swedish Cancer Foundation (0070-B95-09XCC), the Children's Cancer Foundation (1995/035), the Swedish Medical Research Council (B96-16X-05971-16C), the FRF Foundation, the Tobias Foundation and the Ellen Bachrach foundation. We thank Inger Hammarberg for excellent typing of this manuscript and Zoe and Francis Walsh for scrutinizing the language.
Author information
Authors and Affiliations
Consortia
Appendix: contributors
Appendix: contributors
We are indebted to all the following EBMT Teams, which submitted patient data and made this study possible: Univ. Degli Studi La Sapienza, Roma; Inst. Paoli I Calmettes, Marseille; Hôpital Saint Antoine, Paris; Hôpital du Haut Leveque, Pessac; University Hospital, Uppsala; Medizinische Klinik u. Poliklinik V, Heidelberg; University College, London; Hospital Universitario La Fe, Valencia; Hospital Clinic, Barcelona; Ospedale, Bergamo; University Hospital, Essen; Hospital M Infantil Vall d′Hebron, Barcelona; Hôpital Jean Minjoz, Busançon; Hospital Universitario La Fe, Santander; Royal Free Hospital, London; Cattedra di Ematologia, University, Parma; University Hospital, Utrecht; Cliniques Universitaires St Luc, Brussels; Hospital Santa Creu i Saint Pau, Barcelona; Glasgow Royal Infirmary, Glasgow; Hôpital Bretonneau, Tours; Universitat, Leipzig; Inst. Scienze Medicho, Milano; University Hospital, Leiden; Ospedale San Martino, Genova; Royal Victoria Infirmary, Newcastle; King Faisal Specialist Hospital, Riyadh; Hôpital de Purpan, Toulouse; University Hospital, Huddinge; Hospital San Maurizio, Bolzano; Hospital Universitario ′Virgen del Rocio′, Sevilla; Hospital Casa Sollievo Della Softerenza, Giovanni Rotondo; Hospital San Orsola, Bologna; University Hospital Centre-Rebro, Zagreb; Hôtel Dieu, Paris; Hôpital Henri Mondor, Créteil; University Hospital, Torino; Hôpital d′Enfants de la Timone, Marseille; Ospedale di Careggi, Firenze; University Hospital St Radboud, Nijmegen; S Camillo Hospital, Rome; Hôtel Dieu, Nantes; Istituto di Radioterapia, Padova; Policlinico San Malteo, Pavia; Hôpital E Herriot, Lyon; Silesian Medical Academy, Katowice; University Hospital Gasthuisberg, Leuven; Heartlands Hospital, Birmingham; IRCCS Policlinico San Matteo, Pavia; The George Papanicolaou, Exokhi; Hôpital Trosseau, Paris; East Hospital, Göteborg; Universität, Frankfurt; Universita Cattolica S Cuore, Roma; Policlinico Borgo Roma Ematologia, Verona; Dr Daniel den Hoed Cancer Center, Rotterdam; Hôpital de Brabois, Nancy; Ospedale V Cervello, Palermo; Addenbrookes Hospital, Cambridge; Hôpital Debrousse, Lyon; University Hospital, Lund; Istituto per l′Infanzie Burio Garololo, Trieste; Centre Hospitallier Universitaire, Clermont-Ferrand; Pesaro Hospital, Pesaro; University Hospital, Maastricht; ULSSN8 ′Vicenza′ Presidio Ospeda-liero, Vicenza; Kantonspital, Basel; Academisch Ziekenhuis, Amsterdam; Medical School, Hannover; Hospital Covadonga, Oviedo; Hôpital C Nicolic; Rouen; Hôpital St Louis, Paris; Royal University Hospital, Liverpool; Hospital Las Palmas; Karolinska Hospital, Stockholm; CHU, Dijon; Universität, Ulm; Hôpital A Michallon, Grenoble; Hôpital Cimiez, Nice; University, Regensburg; Westminster Hospital, London; Cordoba Hospital; Ospedale Civile, Pescara; Institute G Gaslini, Genova; Spedali Civili, Brescia; Hôpital Sud, Rennes; Hôpital Beaujon, Clichy; University, Liege; Ospedale Oncologico, Cagliari; CHU Lapeyronie, Montpellier; Hôpital la Pitié-Salpétrière, Paris; The London Clinic; Ospedale Regina Margherita, Torino; Hospital Tianjin; Sharlati Hospital, Teheran; Hospital Infantil La Fe, Valencia; Hôpital du Val de Grace, Paris; Institut Gustave Roussy, Villejuif; The Ned Children′s Hospital, Sydney; Hospital Infantil La Paz, Madrid; University of Jena; ′Federico II′ Medical School, Napoli; UCT Medical School, Cape Town; Inst. Portugues Oncologia, Lisboa; University Hospital, Tübingen; Hôpital Paul Brousse, Villejuif; Hôpital Haute-pierre, Strasbourg; Clinica Puerta de Hierro, Madrid; Ospedale di Torrette, Ancona; Royal Marsden Hospital, Surrey; University Hospital, Bern; Royal Infirmary, Edinburgh; Hôpital Cantonal Universitaire, Geneva; Hôpital Cochin, Paris; Ospedale di Niguarda; Milano; Klinikum Grosshadern, München; Antararlida Hospital Pivedo; Buenos Aires; Hôpital Nord, Saint Etienne; Hôpital la Milétrie, Poitiers; Hôpital Claude Huriez, Lille; University Hospital Birmingham NHS Trust; AZ Sint-Jan, Bruggo; Royal Manchester Children′s Hospital, Pandlebury; St Anna Kinderspital, Vienna; Universitätskrankenhaus Eppendorg, Hamburg; CHRU, Angers; CH Intercommunal, Creteil; University Hospital, Udine; Hospital General Universitario, Murcie; Medical Center Hospital, Örebro; University Hospital, Linköping; Istituto di Clinico Pediatrica, Pisa; University Hospital, Helsinki; Centro Trapianti di Midollo Osseo, Cremona; Rikshospitalet, Oslo; University Hospital, Beijing; Herlev Hospital; ULB Hôpital Erasme, Brussels; Institute of Hematology, Praha; CHU A Morvan, Brest; Hospital Reggio Celebri; Hospital Clinico, Salamanca; The Center for Pediatric Hematology Oncology, Petach-Tikva; Institut Catal`a d′Oncologia, Barcelona: King′s College School of Medicine, London; University of Erlangen-Nüremberg, Erlangen; BMT Unit, University, Vienna; University Hospital, Innsbruck; Centre Jean Perrin; Clermond-Ferrand; Hospital Clinico Universitario, Valencia; Inst. Portugues Oncologia BMT Unit, Porto; The Queen Elizabeth Hospital, Woodville; Hospital Nuestra Senora Aranzazu, San Sebastian; University Hospital, Bratislava; Ibni Sina Hospital, Ankara; Århus Amtssygehus, Århus; Charles University Hospital, Pilsen; Universita Tor Verguata, Rome; AZ Middelheim, Antwerp; Ematologia ′Giovanni di Gugliefmo′, Avellino; University of Perugia; Hospital No. 9, Minsk; Hôpital Robert Debré, Paris; CHU Robert Debré, Reims; Hammersmith Hospital, London; Royal South Hants Hospital, Southampton; General Hospital, Lanzhou; Royal Devon and Exeter Hospital, Exeter; Hospital Regional, Malaga; Evangelismos Hospital, Athens; Klinikum Nürnberg, University Hospital VUB, Brussels; University Hospital, Tampere; Hôpital de Brabois, Nancy; Royal Hospital, Perth; Royal Infirmary, Leicester; Hospital Son Durata, Palma de Mallorca; Clinica Corachan, Barcelona; University, Palermo; Hôpital Avicienne, Bobigny; Hôpital Necker, Paris; Great Ormond Street Hospital, London; The Oxford Radcliffe Hospital; St James Hospital Trinity College, Dublin; Humboldt Universität, Berlin; HCI International Medical Centre, Clydebank; Bristol Hospital for Sick Children; BMT Unit, Druski Hospital, Wroclaw; Centre René Huguentin, St Cloud; Military Medical Academy, Belgrade; RG Voll Hebron, Barcelona; University Med. Center, Ljubljana; Russian Institute of Hematology, St Petersburg; K Marcinkowski University of Medical Science, Poznan; YSBYTY, Gwynedd; Clinica Universitaria de Navarra, Pamplona; University Hospital, Gent; ′Aghia Sophia′ Children′s Hospital, Athens; Tel-Aviv University, Tel-Hashomer; Our Lady′s Hospital for Sick Children, Dublin; University of Saarland, Homburg-Saar; University of Catania, Catania; Hospital, Harrow; Derriford Hospital, Plymouth; University, München; Val de Grace, Paris; Hôpital E Miller, Mulhouse; CAC F Daciesse, Caen; Hôpital de Hautepierre, Strasbourg; Hôpital Beaujon, Clichy; CHU, Amiens; Hôpital Pasteur, Colmar.
Rights and permissions
About this article
Cite this article
Ringdén, O., Labopin, M., Gorin, N. et al. The dismal outcome in patients with acute leukaemia who relapse after an autograft is improved if a second autograft or a matched allograft is performed. Bone Marrow Transplant 25, 1053–1058 (2000). https://doi.org/10.1038/sj.bmt.1702409
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1702409
Keywords
This article is cited by
-
Tandem versus single autologous peripheral blood stem cell transplantation as post-remission therapy in adult acute myeloid leukemia patients under 60 in first complete remission: results of the multicenter prospective phase III GOELAMS LAM-2001 trial
Leukemia (2010)
-
A fludarabine, thiotepa reduced toxicity conditioning regimen designed specifically for allogeneic second haematopoietic cell transplantation after failure of previous autologous or allogeneic transplantation
Bone Marrow Transplantation (2008)
-
Autologous stem cell transplant in ALL: who should we be transplanting in first remission?
Bone Marrow Transplantation (2006)
-
High-dose melphalan is an effective salvage therapy in acute myeloid leukaemia patients with refractory relapse and relapse after autologous stem cell transplantation
Annals of Hematology (2005)
-
Low transplant-related mortality after second allogeneic peripheral blood stem cell transplant with reduced-intensity conditioning in adult patients who have failed a prior autologous transplant
Bone Marrow Transplantation (2002)