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Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft.
Haematologica. 2001 Jun; 86(6):646-51.H

Abstract

BACKGROUND AND OBJECTIVES

The risk of relapse after autologous bone marrow transplantation (ASCT) is high and is related to the type of malignancy and phase of the disease. The outcome for the patient who relapses after an autologous transplant is poor. Some of these patients achieve a remission with conventional chemotherapy, but it is usually short-lasting. Most of them succumb to the original disease. One further therapeutic possibility is an allogeneic transplant which would confer the potential advantage of a graft-versus-leukemia effect in addition to the lack of tumor contamination of the graft and to a high-dose intensity conditioning regimen.

DESIGN AND METHODS

We have studied the outcome of 31 patients with hematologic malignancies who underwent an allogeneic hematopoietic stem cell transplant (HSCT) after failing an autologous transplant because of relapse (n=29) or persistent aplasia (n=2). The median age at allograft was 36 years (18-55) and the interval from autograft to allograft was 21 months (3-141). The source of stem-cells was unmanipulated bone marrow (n=26) or growth-factor-mobilized peripheral blood (n=5). The donor was an HLA-identical sibling (n=7), or an alternative donor (n=24) (family mismatched n=11, or matched unrelated n=13). The conditioning regimen was cyclophosphamide and thiotepa (n=22), or cyclophosphamide and total body irradiation (n=9) Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporine (CyA) + methotrexate (MTX).

RESULTS

Acute GvHD was scored as 0-I, II, or III-IV in 39%, 48%, and 13% of the patients, respectively. Sixteen patients died of transplant-related complications and one of progressive disease. With a median follow-up of 220 days (9-2104) the actuarial 2-year transplant-related mortality (TRM) was 51%, the actuarial relapse risk 37%, the actuarial survival 46%. Fifteen patients (48%) are alive in complete remission, with a median follow-up of 32 months (range 2-71).

INTERPRETATION AND CONCLUSIONS

These data suggest that patients relapsing after an autotransplant should be screened for potential related or unrelated donors: although TRM remains high there is a definite chance of long-term disease-free survival if these patients are allografted.

Authors+Show Affiliations

Dipartmento di Ematología, Ospedale San Martino, Genoa, Italy. emato2@smartino.ge.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11418375

Citation

di Grazia, C, et al. "Conventional Hematopoietic Stem Cell Transplants From Identical or Alternative Donors Are Feasible in Recipients Relapsing After an Autograft." Haematologica, vol. 86, no. 6, 2001, pp. 646-51.
di Grazia C, Raiola AM, Van Lint MT, et al. Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft. Haematologica. 2001;86(6):646-51.
di Grazia, C., Raiola, A. M., Van Lint, M. T., Lamparelli, T., Gualandi, F., Berisso, G., Bregante, S., Dominietto, A., Mordini, N., Bruno, B., Frassoni, F., & Bacigalupo, A. (2001). Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft. Haematologica, 86(6), 646-51.
di Grazia C, et al. Conventional Hematopoietic Stem Cell Transplants From Identical or Alternative Donors Are Feasible in Recipients Relapsing After an Autograft. Haematologica. 2001;86(6):646-51. PubMed PMID: 11418375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft. AU - di Grazia,C, AU - Raiola,A M, AU - Van Lint,M T, AU - Lamparelli,T, AU - Gualandi,F, AU - Berisso,G, AU - Bregante,S, AU - Dominietto,A, AU - Mordini,N, AU - Bruno,B, AU - Frassoni,F, AU - Bacigalupo,A, PY - 2001/6/22/pubmed PY - 2002/1/5/medline PY - 2001/6/22/entrez SP - 646 EP - 51 JF - Haematologica JO - Haematologica VL - 86 IS - 6 N2 - BACKGROUND AND OBJECTIVES: The risk of relapse after autologous bone marrow transplantation (ASCT) is high and is related to the type of malignancy and phase of the disease. The outcome for the patient who relapses after an autologous transplant is poor. Some of these patients achieve a remission with conventional chemotherapy, but it is usually short-lasting. Most of them succumb to the original disease. One further therapeutic possibility is an allogeneic transplant which would confer the potential advantage of a graft-versus-leukemia effect in addition to the lack of tumor contamination of the graft and to a high-dose intensity conditioning regimen. DESIGN AND METHODS: We have studied the outcome of 31 patients with hematologic malignancies who underwent an allogeneic hematopoietic stem cell transplant (HSCT) after failing an autologous transplant because of relapse (n=29) or persistent aplasia (n=2). The median age at allograft was 36 years (18-55) and the interval from autograft to allograft was 21 months (3-141). The source of stem-cells was unmanipulated bone marrow (n=26) or growth-factor-mobilized peripheral blood (n=5). The donor was an HLA-identical sibling (n=7), or an alternative donor (n=24) (family mismatched n=11, or matched unrelated n=13). The conditioning regimen was cyclophosphamide and thiotepa (n=22), or cyclophosphamide and total body irradiation (n=9) Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporine (CyA) + methotrexate (MTX). RESULTS: Acute GvHD was scored as 0-I, II, or III-IV in 39%, 48%, and 13% of the patients, respectively. Sixteen patients died of transplant-related complications and one of progressive disease. With a median follow-up of 220 days (9-2104) the actuarial 2-year transplant-related mortality (TRM) was 51%, the actuarial relapse risk 37%, the actuarial survival 46%. Fifteen patients (48%) are alive in complete remission, with a median follow-up of 32 months (range 2-71). INTERPRETATION AND CONCLUSIONS: These data suggest that patients relapsing after an autotransplant should be screened for potential related or unrelated donors: although TRM remains high there is a definite chance of long-term disease-free survival if these patients are allografted. SN - 0390-6078 UR - https://www.unboundmedicine.com/medline/citation/11418375/Conventional_hematopoietic_stem_cell_transplants_from_identical_or_alternative_donors_are_feasible_in_recipients_relapsing_after_an_autograft_ L2 - https://antibodies.cancer.gov/detail/CPTC-HLA-DPB1-2 DB - PRIME DP - Unbound Medicine ER -