2nd Allo Transplant May Be Effective in Acute Leukemias

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Second Stem Cell Transplant Effective for Relapsed

Acute Leukemia

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WESTPORT, CT (Reuters Health) Aug 28 - A repeat

hematopoietic stem-cell transplant (HSCT) may be

effective treatment for acute leukemia patients who

relapse after allogeneic HSCT, according to a report

in the August 15th Journal of Clinical Oncology.

Leukemia recurs in 10% to 70% of patients after

allogeneic HSCT, the authors note, and the optimal

treatment at that point is open to question. Dr.

Alberto Bosi, from the University of Florence, Italy,

and colleagues in the European Blood and Marrow

Transplant Group retrospectively analyzed the outcome

of second HSCT in 170 patients with acute myeloid

leukemia or acute lymphoid leukemia who experienced

relapse after their first HSCT.

Engraftment occurred in 97% of patients after second

HSCT, the authors report, with restoration of

neutrophil counts in a median 16 days and platelet

counts in a median 28 days. The actuarial 5-year

survival rate was 26%. At 5 years after second HSCT

the leukemia-free survival rate was 25% and the

relapse rate was 59%.

Acute graft-versus-host disease (GVHD) was more common

after the second HSCT than after the first HSCT (p <

0.0001), the researchers note. Chronic GVHD occurred

in a limited form in 12% of patients and in an

extensive form in 20%. Patients with acute GVHD after

their second HSCT had better outcomes in terms of

leukemia-free survival and relapse than did those

without acute GVHD.

In a multivariate analysis, better outcomes were more

likely in patients with long intervals to relapse

after first HSCT, acute GVHD at first or second HSCT,

complete remission status at second HSCT, the use of

total body irradiation at second HSCT, and the use of

bone marrow as the source of stem cells for the second

HSCT, the report indicates.

In fact, the investigators say, the group most likely

to benefit from second HSCT includes patients who are

in second complete remission at the time of their

second HSCT and who experience relapse more than 292

days after their first HSCT.

" The results of this study show that second HSCT may

represent a real chance for a subset of acute leukemia

patients who experience relapse after allogeneic

HSCT, " the authors conclude. " Patients should be

treated during relapse before HSCT to obtain a new

remission. "

J Clin Oncol 2001;19:3675-3684.

http://www.medscape.com/reuters/prof/2001/08/08.29/20010828clin005.html

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