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Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant
BACKGROUND: Second allogeneic hematopoietic stem cell transplant (HCT) remains as an option for disease relapse after initial HCT. METHODS: We analyzed retrospectively the outcomes of 65 consecutive patients who underwent a second HCT for disease relapse at the University of Chicago. Univariate and...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317199/ https://www.ncbi.nlm.nih.gov/pubmed/30622841 http://dx.doi.org/10.1186/s40164-018-0125-6 |
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author | Fan, Yun Artz, Andrew S. van Besien, Koen Stock, Wendy Larson, Richard A. Odenike, Olatoyosi Godley, Lucy A. Kline, Justin Cunningham, John M. LaBelle, James L. Bishop, Michael R. Liu, Hongtao |
author_facet | Fan, Yun Artz, Andrew S. van Besien, Koen Stock, Wendy Larson, Richard A. Odenike, Olatoyosi Godley, Lucy A. Kline, Justin Cunningham, John M. LaBelle, James L. Bishop, Michael R. Liu, Hongtao |
author_sort | Fan, Yun |
collection | PubMed |
description | BACKGROUND: Second allogeneic hematopoietic stem cell transplant (HCT) remains as an option for disease relapse after initial HCT. METHODS: We analyzed retrospectively the outcomes of 65 consecutive patients who underwent a second HCT for disease relapse at the University of Chicago. Univariate and multivariate analysis were conducted, and a scoring system was generated to select the patients who would benefit second HCT. RESULTS: All except four patients received T cell depleted (TCD) first HCT. The majority of patients had AML (n = 47) and high risk MDS (n = 5). The median age at second HCT was 45 years (11–73). 13 patients (20%) achieved CR before second HCT. 98% (n = 64) and 72% (n = 47) patients achieved neutrophil and platelet engraftment at a median interval of 10 and 18 days, respectively, following the second HCT. With a median follow up of 23 (5.5–140) months for survivors after second HCT, the estimated 2 years PFS was 17.5% and the 2 years OS was 22.6%. The day 100 cumulative incidence of non-relapse mortality rate was 23.6%, and the cumulative incidence of aGVHD and cGVHD were 16.9% and 7.7% respectively at 1 year after second HCT. In univariate analysis, patients with remission duration after first HCT of > 12 months and those in CR before second HCT had significantly better PFS and OS. A scoring system using disease status before second HCT (CR = 0 vs. non-CR = 1), and remission duration after first HCT (< 6 = 2, 6–12 = 1 and > 12 months = 0) was generated as an approach to classify patients into different risk categories in the purpose to provide guidance to the transplant physician to inform the outcomes to potential patients undergoing 2nd HCT. A score of < 2 (n = 26) identified a group with PFS and OS of 31.6% and 36.2% at 2 years after second HCT. CONCLUSION: In conclusion, second HCT is a viable option for disease relapse after TCD HCT for patients entering second HCT in remission and/or remission duration > 12 months after first HCT with acceptable rates of GVHD and donor engraftment. |
format | Online Article Text |
id | pubmed-6317199 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63171992019-01-08 Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant Fan, Yun Artz, Andrew S. van Besien, Koen Stock, Wendy Larson, Richard A. Odenike, Olatoyosi Godley, Lucy A. Kline, Justin Cunningham, John M. LaBelle, James L. Bishop, Michael R. Liu, Hongtao Exp Hematol Oncol Research BACKGROUND: Second allogeneic hematopoietic stem cell transplant (HCT) remains as an option for disease relapse after initial HCT. METHODS: We analyzed retrospectively the outcomes of 65 consecutive patients who underwent a second HCT for disease relapse at the University of Chicago. Univariate and multivariate analysis were conducted, and a scoring system was generated to select the patients who would benefit second HCT. RESULTS: All except four patients received T cell depleted (TCD) first HCT. The majority of patients had AML (n = 47) and high risk MDS (n = 5). The median age at second HCT was 45 years (11–73). 13 patients (20%) achieved CR before second HCT. 98% (n = 64) and 72% (n = 47) patients achieved neutrophil and platelet engraftment at a median interval of 10 and 18 days, respectively, following the second HCT. With a median follow up of 23 (5.5–140) months for survivors after second HCT, the estimated 2 years PFS was 17.5% and the 2 years OS was 22.6%. The day 100 cumulative incidence of non-relapse mortality rate was 23.6%, and the cumulative incidence of aGVHD and cGVHD were 16.9% and 7.7% respectively at 1 year after second HCT. In univariate analysis, patients with remission duration after first HCT of > 12 months and those in CR before second HCT had significantly better PFS and OS. A scoring system using disease status before second HCT (CR = 0 vs. non-CR = 1), and remission duration after first HCT (< 6 = 2, 6–12 = 1 and > 12 months = 0) was generated as an approach to classify patients into different risk categories in the purpose to provide guidance to the transplant physician to inform the outcomes to potential patients undergoing 2nd HCT. A score of < 2 (n = 26) identified a group with PFS and OS of 31.6% and 36.2% at 2 years after second HCT. CONCLUSION: In conclusion, second HCT is a viable option for disease relapse after TCD HCT for patients entering second HCT in remission and/or remission duration > 12 months after first HCT with acceptable rates of GVHD and donor engraftment. BioMed Central 2019-01-03 /pmc/articles/PMC6317199/ /pubmed/30622841 http://dx.doi.org/10.1186/s40164-018-0125-6 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Fan, Yun Artz, Andrew S. van Besien, Koen Stock, Wendy Larson, Richard A. Odenike, Olatoyosi Godley, Lucy A. Kline, Justin Cunningham, John M. LaBelle, James L. Bishop, Michael R. Liu, Hongtao Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title | Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title_full | Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title_fullStr | Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title_full_unstemmed | Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title_short | Outcomes following second allogeneic stem cell transplant for disease relapse after T cell depleted transplant correlate with remission status and remission duration after the first transplant |
title_sort | outcomes following second allogeneic stem cell transplant for disease relapse after t cell depleted transplant correlate with remission status and remission duration after the first transplant |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317199/ https://www.ncbi.nlm.nih.gov/pubmed/30622841 http://dx.doi.org/10.1186/s40164-018-0125-6 |
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