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. 2023 Aug;58(8):907-915.
doi: 10.1038/s41409-023-01985-7. Epub 2023 May 9.

Second haploidentical stem cell transplantation (HAPLO-SCT2) after relapse from a first HAPLO-SCT in acute leukaemia-a study on behalf of the Acute Leukaemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Giuliano Filippini Velázquez  1 , Myriam Labopin  2   3 , Johanna Tischer  4 , Anna Maria Raiola  5 , Emanuele Angelucci  5 , Alexander D Kulagin  6 , Piero Galieni  7 , Arancha Bermúdez  8 , Claude-Eric Bulabois  9 , Nicolaus Kröger  10 , José Luis Díez-Martín  11 , Mi Kwon  11 , Arnon Nagler  12 , Christoph Schmid  13 , Fabio Ciceri  14 , Mohamad Mohty  3
Affiliations

Second haploidentical stem cell transplantation (HAPLO-SCT2) after relapse from a first HAPLO-SCT in acute leukaemia-a study on behalf of the Acute Leukaemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Giuliano Filippini Velázquez et al. Bone Marrow Transplant. 2023 Aug.

Abstract

For patients with acute myeloid and lymphoblastic leukaemia (AML/ALL) lacking a matched sibling or unrelated donor, haploidentical stem cell transplantation (HAPLO-SCT) is increasingly used. However, available data on the treatment of relapse after HAPLO-SCT, including feasibility and efficacy of a second HAPLO-SCT (HAPLO-SCT2), is scarce. Hence, adults with AML/ALL, that had undergone HAPLO-SCT2 without ex-vivo manipulation after haematologic relapse from HAPLO-SCT1 were selected for a retrospective registry analysis. Eighty-two patients (AML, n = 63, ALL, n = 19, median follow-up: 33 months) were identified. Engraftment rate was 87%. At day +180, cumulative incidences of acute GvHD II-IV°/chronic GvHD were 23.9%/22.6%, respectively. Two-year overall survival/leukaemia-free survival (OS/LFS) were 34.3%/25.4%; 2-year non-relapse mortality (NRM) and relapse incidence (RI) were 17.6% and 57%. Leukaemia was the most frequent cause of death. Separated by disease, 2-year OS/LFS/NRM/RI were 28.7%/22.3%/16.2%/61.6% in AML, and 55.3%/38.4%/23.5%/38.2% in ALL patients. In a risk-factor analysis among patients with AML, stage at HAPLO-SCT1 and HAPLO-SCT2, and interval from HAPLO-SCT1 to relapse significantly influenced outcome. Our data demonstrate that HAPLO-SCT2 is a viable option in acute leukaemia relapse after HAPLO-SCT1. Engraftment, toxicity, risk factors and long-term outcome are comparable to data reported after allo-SCT2 in a matched donor setting.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Outcome after second HAPLO-SCT in 82 patients with acute leukaemia.
RI relapse incidence, NRM non-relapse mortality, LFS leukaemia-free survival, OS overall survival.
See this image and copyright information in PMC

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