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Outcomes of third allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute leukemia after a second transplantation

Bone Marrow Transplantation volume 57, pages 43–50 (2022)Cite this article

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Abstract

Relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with poor prognosis. In a subset of patients, durable remissions can be achieved with a second allo-HSCT (allo-HSCT2). However, many patients experience relapse after allo-HSCT2 and they may be considered for a third allo-HSCT (allo-HSCT3). Nevertheless, the benefit of allo-HSCT3 remains unconfirmed. Thus, herein a retrospective analysis of 253 allo-HSCT3s in patients with relapsed/refractory acute leukemia was carried out. In total, 29 (11.5%) survived at a median follow-up of 794 days (range: 87–4 619). The 3-year leukemia-free survival and overall survival (OS) rates were 9.7% and 10.9%, respectively. Patients who maintained remission for ≥2 years after allo-HSCT2 had a significantly better 3-year OS (35.8%) than those who experienced early relapse (<1 year, 7.8%; 1–2 years, 14.0%; P = 0.004). Complete remission at allo-HSCT3, performance status score of 0–1 at allo-HSCT3, grade I acute graft-versus-host disease after allo-HSCT2, and relapse ≥2 years after allo-HSCT2 were associated with better survival in patients who received allo-HSCT3. The prognosis after allo-HSCT3 in patients with relapsed/refractory acute leukemia is generally unfavorable. However, given the lack of alternative treatment options, allo-HSCT3 may be considered in a group of patients.

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Fig. 1: Outcomes after a third allogeneic hematopoietic stem cell transplantation.
Fig. 2: Subgroup analysis for patients who underwent a third allogeneic hematopoietic stem cell transplantation.
Fig. 3: Outcomes after a third allogeneic hematopoietic stem cell transplantation.

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Acknowledgements

We thank all the physicians and the staff at the centers who contributed to the collection of clinical data for the Transplant Registry Unified Management Program of the Japanese Data Center for Hematopoietic Cell Transplantation.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan

    Shinichi Kobayashi & Fumihiko Kimura

  2. Division of Hematology, Jichi Medical University, Tochigi, Japan

    Yoshinobu Kanda

  3. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

  4. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Chuo City, Tokyo, Japan

    Yoshihiro Inamoto & Takahiro Fukuda

  5. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    Kimikazu Matsumoto

  6. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  7. Department of Hematology, Hyogo College of Medicine Hospital, Hyogo, Japan

    Kazuhiro Ikegame

  8. Hematology, Oncology & Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan

    Toshihiro Miyamoto

  9. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  10. Hematology, Osaka City University Hospital, Osaka, Japan

    Hirohisa Nakamae

  11. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  12. Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Satoshi Takahashi

  13. Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan

    Souichi Shiratori

  14. Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan

    Shoji Saito

  15. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  16. Department of Hematology and Oncology, Graduate School of Medicine, KyotoUniversity, Kyoto, Japan

    Junya Kanda

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  18. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

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  1. Shinichi Kobayashi
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Contributions

SK designed the study, organized the project, performed the statistical analysis, and analyzed the data; YKanda, TKonuma, YI, KM, and FK analyzed and interpreted the data; NU, KI, TM, ND, HN, YKatayama, ST, SShiratori, SSaito, TKawakita, JK, TF, and YA gathered and organized the data; SK wrote the first draft and all other authors contributed to the final version.

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Correspondence to Shinichi Kobayashi.

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Kobayashi, S., Kanda, Y., Konuma, T. et al. Outcomes of third allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute leukemia after a second transplantation. Bone Marrow Transplant 57, 43–50 (2022). https://doi.org/10.1038/s41409-021-01485-6

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