Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution

Citation
C. Martinez et al., Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution, LEUK RES, 25(5), 2001, pp. 379-384
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Onconogenesis & Cancer Research
Journal title
LEUKEMIA RESEARCH
ISSN journal
0145-2126 → ACNP
Volume
25
Issue
5
Year of publication
2001
Pages
379 - 384
Database
ISI
SICI code
0145-2126(200105)25:5<379:ASCTAS>2.0.ZU;2-1
Abstract
The prognosis of patients relapsing after an autologous transplant (autoSCT ) is very poor. Allogenic stem cell transplantation (alloSCT) offers the po ssibility of curing some of these patients, at the cost, however, of a high transplant related mortality (TRM). The aim of this study was to analyze t he outcome of 14 consecutive patients with hematologic malignancies, from a single institution, who underwent alloSCT for progressive disease after au toSCT. Patients had relapsed at a median of 11.5 months (range 2-72) after autoSCT and they underwent alloSCT at a median of 25.5 months (range 7-73) from the first transplant. Ten patients received HLA-identical related peri pheral blood progenitor cells, three patients underwent matched-unrelated d onor marrow transplants, and one patient received a mismatched related tran splant. Conditioning regimens consisted of total body irradiation plus cycl ophosphamide (n = 5) or melphalan (n = 1), or high-dose combination chemoth erapy (n = 8). Cyclosporin A and methothrexate were administered as graft-v ersus-host disease (GVHD) prophylaxis. Eight patients (57%) developed grade II-IV acute GVHD. All evaluable patients (n = 6) presented extensive chron ic GVHD. Overall survival at 1 year was 16% (median 3.5 months, 95% CI 0.7- 10.3). Ten patients (71%) died from transplant related complications at a m edian of 3.5 months (range 0.7-11). Only one patient died of recurrent dise ase. Three patients remain alive and in complete remission at the time of t his report (4, 20 and 20 months, respectively). In conclusion, alloSCT offe rs the possibility of a sustained control of the disease in some patients w ho relapse after an autoSCT. However, the procedure is associated with a hi gh transplant-related mortality. Better results might be obtained by carefu lly selecting patients and by reducing the intensity of the preparative reg imen. (C) 2001 Elsevier Science Ltd. AII rights reserved.