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Review
. 2016 Dec;29(4):359-364.
doi: 10.1016/j.beha.2016.10.011. Epub 2016 Oct 19.

The role of second transplants for leukemia

Daniel Weisdorf  1
Affiliations
Review

The role of second transplants for leukemia

Daniel Weisdorf. Best Pract Res Clin Haematol. 2016 Dec.

Abstract

Management of relapsed leukemia following allogeneic transplantation is challenging. Intensive chemotherapy, donor lymphocyte infusions (DLI), or second transplantation have some value, but most reported series describe only a limited number of patients surviving beyond 2 or 3 years following relapse. Additionally, understandable selection-bias of reports describing the outcomes of intensive management approaches for relapsed leukemia confound generalizability to a broader population. However numerous reports suggest that second allogeneic transplantation for relapsed leukemia following an initial transplant may produce extended disease control and survival for patients with favorable performance status, remission at the time of second transplant, and most importantly a long interval between initial transplant and relapse. Reduced intensity conditioning for second allografts may be preferable and little data exists to suggest that a new donor will improve disease control by inducing a stronger graft-versus-leukemia effect. Improved measures to prevent the first relapse, however, may protect more patients and produce a greater fraction enjoying extended leukemia-free survival.

Keywords: Allogeneic; Allotransplant; CIBMTR; Center for International Blood and Marrow Transplant Research; DLI; Donor lymphocyte infusion; EBMT; European Group for Blood and Marrow Transplant; HCT; Hematopoietic cell transplantation; Leukemia; Second transplant.

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Conflict of interest statement

Daniel Weisdorf received consulting fees from Alexion, Kadmon, Enlivex, Amgen, Onyx.

Figures

Fig. 1
Fig. 1
Survival following relapse after allogeneic HCT for AML. Longer survival with later relapse (from Bejanyan et al., 2015 [1]).
Fig. 2
Fig. 2
Survival after 2nd allogeneic HCT for AML: no advantage of changing donors in relapse (REL), non relapse mortality (NRM), overall survival (OS) or relapse-free survival (RFS). Black line same donor (n = 1884); gray line different donor (n = 712) (from Ruutu et al., 2015 [27]. Reprinted by permission from Macmillan Publishers Ltd: Bone Marrow Transplant, copyright 2015.).
Fig. 3
Fig. 3
Survival following URD HCT for relapse after autologous transplantation for AML. Risk factor analysis based upon one or more of the following significant risk factors [relapse < 18 months post autograft: not in CR at URD HCT; myeloablative conditioning; KPS < 90%; CMV seropositive] (from Foran et al., 2013 [29]).
See this image and copyright information in PMC

References

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