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Second haploidentical peripheral blood stem cell transplantation for treatment of acute leukemia with relapse after first allogeneic peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 50, pages 1001–1003 (2015)Cite this article

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For patients with acute leukemia who relapse after the first allogeneic transplantation (hematopoietic stem cell transplantation 1 (HSCT1)), the choice of curative treatments is limited, and includes mainly DLI and a second allogeneic transplantation (HSCT2). If the patient fails salvage treatment and the BM blast count remains high, long-term disease-free survival is highly unlikely to be achieved using DLI1 and a second allogeneic transplant is probably the only curative treatment for the very high-risk patient. For the second allogeneic transplantation, the donor can be the same as for the HSCT1, a HLA-matched sibling (MSD) or unrelated donor (MUD), or even HLA-mismatched alternative donors. Of these, the use of a HLA-haploidentical donor would be of particular advantage for the high-risk patient, in that it is easier and rapidly available and would have a potentially stronger GVL effect compared with other donors;2, 3 however, the risk of graft failure and GVHD remains a great concern. Tischer et al.4 recently published an elegant study on using haploidentical HSCT2 for the treatment of 20 patients with relapsed acute leukemia after allogeneic HSCT1. Here, we report our experience using haploidentical transplantation for the treatment of five consecutive patients with acute leukemia who relapsed after the first allogeneic transplant. The differences in the procedure and outcome between our study and the study by Tischer et al.4and the potential clinical implication are discussed.

For HSCT1, all the patients received myeloablative conditioning except case no. 5, a patient who received reduced-intensity conditioning (RIC) because of old age. The stem cell sources were PBSCs from a MSD in case no. 2 and a MUD or mismatched MUD for the other four patients. According to the regulations of Buddhist Tzu Chi Stem Cells Center, the only marrow donor registry in Taiwan, donors of PBSCs can donate only once in their lifetime. Also, the original sibling donor in case no. 2 refused to donate SCs again. As no other HLA-matched donor was available, a haploidentical donor was the only choice for these patients (Table 1).

Table 1 Characteristics of patients
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Acknowledgements

We are grateful to all of the nursing staff at the 5H BMT unit of CMUH for their excellent care of our transplant patients.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    S-P Yeh, C-C Lin, C-H Lin, W-C Lo, T-T Chen & C-F Chiu

  2. Department of Medical Research, Stem Cell Research Lab, China Medical University Hospital, Taichung, Taiwan

    S-P Yeh, W-J Lo & C-L Lin

  3. School of Medicine, China Medical University, Taichung, Taiwan

    S-P Yeh & C-F Chiu

  4. Regency Specialist Hospital, No.1 Jalan Suria, Bandar Seri Alam, Masai, Malaysia

    W-C Lo

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  1. S-P Yeh
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Correspondence to S-P Yeh.

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Competing interests

This work was supported in part by research grants from the Taiwan National Science Council (NSC-101-2321-B-039-005 to S-PY) and the China Medical University Hospital (DMR-99-010 to S-PY). The remaining authors declare no conflict of interest.

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Yeh, SP., Lin, CC., Lin, CH. et al. Second haploidentical peripheral blood stem cell transplantation for treatment of acute leukemia with relapse after first allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 50, 1001–1003 (2015). https://doi.org/10.1038/bmt.2015.67

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