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Conditioning Regimens

Outcome of second allogeneic transplants using reduced-intensity conditioning following relapse of haematological malignancy after an initial allogeneic transplant

Bone Marrow Transplantation volume 42, pages 783–789 (2008)Cite this article

Abstract

Disease relapse following an allogeneic transplant remains a major cause of treatment failure, often with a poor outcome. Second allogeneic transplant procedures have been associated with high TRM, especially with myeloablative conditioning. We hypothesized that the use of reduced-intensity conditioning (RIC) would decrease the TRM. We performed a retrospective national multicentre analysis of 71 patients receiving a second allogeneic transplant using RIC after disease relapse following an initial allogeneic transplant. The majority of patients had leukaemia/myelodysplasia (MDS) (N=57), nine had lymphoproliferative disorders, two had myeloma and three had myeloproliferative diseases. A total of 25% of patients had unrelated donors. The median follow-up was 906 days from the second allograft. The predicted overall survival (OS) and TRM at 2 years were 28 and 27%, respectively. TRM was significantly lower in those who relapsed late (>11 months) following the first transplant (2 years: 17 vs 38% in early relapses; P=0.03). Two factors were significantly associated with a better survival: late relapse (P=0.014) and chronic GVHD following the second transplant (P=0.014). These data support our hypothesis that the second RIC allograft results in a lower TRM than using MA. A proportion of patients achieved a sustained remission even when relapsing after a previous MA transplant.

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Acknowledgements

We thank all of the UK transplant teams who have contributed patients to this study.

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Authors and Affiliations

  1. Department of Haematology, Royal Marsden Hospital, Institute of Cancer Research, London, UK

    B E Shaw

  2. Anthony Nolan Research Institute, Royal Free Hospital, London, UK

    B E Shaw

  3. Department of Haematology, Kings College Hospital, London, UK

    G J Mufti & A Pagliuca

  4. Department of Medicine, Royal Free and University College London School of Medicine, London, UK

    S Mackinnon, R Chakraverty & K J Thomson

  5. Department of Haematology, Barts Hospital, London, UK

    J D Cavenagh

  6. British Society for Blood and Marrow Transplantation, London, UK

    R M Pearce & K E Towlson

  7. Department of Haematology, Hammersmith Hospital, London, UK

    J F Apperley

  8. Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK

    C F Craddock

  9. Department of Haematology, Guys Hospital, London, UK

    M A Kazmi

  10. Department of Haematology, John Radcliffe Hospital, Oxford, UK

    T J Littlewood

  11. Department of Haematology, Heartlands Hospital, Birmingham, UK

    D W Milligan

  12. Department of Haematology, Bristol Childrens Hospital, Bristol, UK

    D I Marks

  13. Department of Haematology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK

    N H Russell

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  1. B E Shaw
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Correspondence to B E Shaw.

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Shaw, B., Mufti, G., Mackinnon, S. et al. Outcome of second allogeneic transplants using reduced-intensity conditioning following relapse of haematological malignancy after an initial allogeneic transplant. Bone Marrow Transplant 42, 783–789 (2008). https://doi.org/10.1038/bmt.2008.255

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