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Acute Leukemia

Second haematopoietic SCT using HLA-haploidentical donors in patients with relapse of acute leukaemia after a first allogeneic transplantation

Bone Marrow Transplantation volume 49, pages 895–901 (2014)Cite this article

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Abstract

Haploidentical haematopoietic SCT (HSCT) using T-cell-replete grafts and post-transplant high-dose CY has found increasing acceptance. Our purpose was to evaluate the feasibility and outcome of this strategy as second HSCT incorporating donor change for acute leukaemia relapse after a first allogeneic transplantation. The courses of 20 consecutive adults (median age 37 years, 12 male) with AML (n=14), ALL (n=5) and acute bi-phenotypic leukaemia (n=1) were analysed retrospectively. Conditioning consisted of fludarabine, CY and either melphalan or TBI or tresosulfan+/–etoposide. Engraftment was achieved in 17 (85%), and a second remission was induced in 15 patients (75%) on day +30. The rate of grade II–IV acute GvHD was 35%, while chronic GvHD occurred in five patients. Most commonly observed grade III–IV toxicities were mucositis (30%), hyperbilirubinemia (20%), elevation of transaminases (20%) and creatinine (20%), while invasive fungal infection affected 30%. One-year non-relapse mortality (NRM) was 36%. At a median follow-up of 17 months, estimated 1-year OS was 45%, and 1-year relapse-free survival was 33%. This strategy was feasible and allowed for successful engraftment with a moderate rate of toxicity. Early outcome and NRM are at least comparable with results after a second HSCT from HLA-matched donors without donor change at HSCT2.

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Acknowledgements

We thank the medical staff of our transplant wards for excellent care of our patients and M Rothmayer for transplantation coordination.

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Author notes

  1. C Schmid and A Hausmann: These authors contributed equally to this study.

Authors and Affiliations

  1. Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation Unit, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Munich, Germany

    J Tischer, N Engel, S Fritsch, D Prevalsek, M Hubmann, C Schulz, A K Zoellner, V Bücklein, S Lippl, R Reibke, C T Rieger, G Ledderose, H J Stemmler, W Hiddemann & A Hausmann

  2. Department of Internal Medicine II, Klinikum Augsburg, Augsburg, Germany

    C Schmid

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Correspondence to J Tischer.

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Tischer, J., Engel, N., Fritsch, S. et al. Second haematopoietic SCT using HLA-haploidentical donors in patients with relapse of acute leukaemia after a first allogeneic transplantation. Bone Marrow Transplant 49, 895–901 (2014). https://doi.org/10.1038/bmt.2014.83

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