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Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Bone Marrow Transplantation volume 58, pages 1008–1016 (2023)Cite this article

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Abstract

Second transplantation (HSCT2) is a potential treatment for primary graft failure (pGF). We assessed the outcome of HSCT2, performed between 2000 and 2021, for pGF in 243 patients with acute leukemia. Median age was 44.8 years. Conditioning at first HSCT (HSCT1) was myeloablative (MAC) in 58.4%. Median time from HSCT1 to HSCT2 was 48 days. Donors for HSCT2 were the same as for HSCT1 in 49%. Engraftment post HSCT2 was achieved by 73.7% of patients. The incidence of acute (a) graft versus host disease (GVHD) grades II-IV and III-IV was 23.2 and 8.1%. 5-year total and extensive chronic (c) GVHD was 22.3 and 10.1%. 5-year nonrelapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD free, relapse-free survival (GRFS) was 51.6, 18.8, 29.6, 30.7 and 22.4%, respectively. Infections were the main cause of death. In multivariable analysis, being transplanted at second vs. first remission, lower Karnofsky performance status (KPS; <90) and receiving MAC at HSCT1 were adverse prognostic factors for NRM, LFS, OS, and GRFS, as was increased age for NRM, LFS, OS. We conclude that HSCT2 can rescue about a third of the patients who experienced pGF, but NRM is as high as 50%.

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Fig. 1: Second allogeneic stem cell transplantation (HSCT2) outcome for primary graft failure in patients with acute leukemia in remission.

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AN, ML, and MM had full access to all study data (available upon data-specific request).

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Author information

Authors and Affiliations

  1. Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel

    Arnon Nagler

  2. EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France

    Myriam Labopin & Mohamad Mohty

  3. Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France

    Myriam Labopin & Mohamad Mohty

  4. Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

    Ryszard Swoboda

  5. First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia

    Alexander Kulagin

  6. Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Ospedale Santa Maria della, Perugia, Italy

    Andrea Velardi

  7. Hematology Department, University Hospital La Fe, Valencia, Spain

    Jaime Sanz

  8. Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France

    Hélène Labussière-Wallet

  9. Dept. of Haematological Medicine, Kings College Hospital, London, United Kingdom

    Victoria Potter

  10. University Medical Centre Dept. of Haematology, Utrecht, The Netherlands

    Jürgen Kuball

  11. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy

    Simona Sica

  12. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy

    Simona Sica

  13. National Research Center for Hematology, Bone Marrow Transplantation, Moscow, Russia

    Elena Parovichnikova

  14. Universitaet Tuebingen, Medizinische Klinik, Tuebingen, Germany

    Wolfgang Bethge

  15. Hopital La Miletrie Bone Marrow TransplantUnit, Clinical Hematology, Poitiers, France

    Natacha Maillard

  16. Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany

    Uwe Platzbecker

  17. Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany

    Friedrich Stölzel

  18. Department of Medicine II, Division for Stem Cell Transplantation and Cellular Immunotherapy, University Hospital Schleswig-Holstein Kiel, Kiel University, Kiel, Germany

    Friedrich Stölzel

  19. Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy

    Fabio Ciceri

  20. Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France

    Mohamad Mohty

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  1. Arnon Nagler
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Contributions

AN wrote the manuscript, designed the study, and interpreted the data. RS helped writing the first draft of the manuscript and reviewed the manuscript. ML and MM designed the study, performed the statistical analyses, interpreted the data, and edited the manuscript. AK, AV, JS, HLW, VP, JK, SS, EP, WB, XL, UP, FS, FC reviewed the manuscript and provided clinical data. All authors approved the final version of the manuscript.

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Correspondence to Arnon Nagler.

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Nagler, A., Labopin, M., Swoboda, R. et al. Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 58, 1008–1016 (2023). https://doi.org/10.1038/s41409-023-02012-5

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