Outcome of second/third allogeneic hematopoietic stem cell transplantations for a relapse of acute leukemia after the first transplantation

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  • 急性白血病の同種造血幹細胞移植後再発に対する再同種移植治療の後方視的解析: 再移植後早期死亡の危険因子について

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Background: Although a second allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be a curative treatment for patients with acute leukemia who have relapsed after the first allo-HSCT, its disadvantages for patients may be too great given the high rate of transplantation-related morbidity and mortality. We aimed to identify the risk factors predicting early mortality after a second/third allo-HSCT.<br>Methods: We retrospectively analyzed the medical records of patients with acute leukemia who underwent allo-HSCTs twice or more in Tenri Hospital between December 1998 and April 2012.<br>Results: Eighteen patients, consisting of 12 with acute myeloid leukemia and 6 with acute lymphoblastic leukemia, were included. Six patients survived for >1 year, while 6 patients died within 60 days after the second allo-HSCT, and 17 patients finally died. The median overall survival time was 178 days. Concurrent infection, moderate/severe liver injury, and higher H(S)CT-specific comorbidity index (CI) score were significantly associated with mortality within 60 days. The median survival times of patients with HCT-CI scores 0, 1/2, and >3 were 335, 313, and 26 days, respectively, and the survival of the last was significantly worse than that of the former two groups. Three patients who underwent a third allo-HSCT for relapsing/refractory leukemia died within 60 days after the transplant. A total of nine patients who died <60 days after the second/third allo-HSCT developed significant morbidities of the lung, gastrointestinal tract, and central nervous system.<br>Conclusion: Second allo-HSCT recipients with concurrent infection, moderate/severe liver injury, and higher HCT-CI scores have a greater likelihood of early mortality and are unlikely to benefit from the transplant.

Journal

  • Tenri Medical Bulletin

    Tenri Medical Bulletin 16 (1), 17-24, 2013

    Tenri Foundation, Tenri Institute of Medical Research

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