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Acute Leukemia

Second reduced intensity conditioning allogeneic transplant as a rescue strategy for acute leukaemia patients who relapse after an initial RIC allogeneic transplantation: analysis of risk factors and treatment outcomes

Bone Marrow Transplantation volume 51, pages 186–193 (2016)Cite this article

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Abstract

Limited therapeutic options are available after relapse of acute leukaemia following first reduced intensity conditioning haematopoietic stem cell transplantation (RIC1). A retrospective study on European Society for Blood and Marrow Transplantation (EBMT) registry data was performed on 234 adult patients with acute leukaemia who received a second RIC transplantation (RIC2) from 2000 to 2012 as a salvage treatment for relapse following RIC1. At the time of RIC2, 167 patients (71.4%) had relapsed or refractory disease, 49 (20.9%) were in second CR and 18 (7.7%) in third or higher CR. With a median follow-up of 21 (1.5–79) months after RIC2, 51 patients are still alive. At 2 years, the cumulative incidence of non-relapse mortality (NRM), relapse incidence (RI), leukaemia-free survival (LFS) and overall survival (OS) were 22.4% (95% confidence interval (CI): 17–28.4), 63.9% (56.7–70.1), 14.6% (8.8–18.5) and 20.5% (14.9–26.1), respectively. In patients with acute myelogenous, biphenotypic and undifferentiated leukaemia (representing 89.8% of all patients), duration of remission following RIC1 >225 days, presence of CR at RIC2, patient’s Karnofsky performance status >80 at RIC2 and non-myeloablative conditioning were found to be the strongest predictors of patients’ favourable outcome.

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Acknowledgements

MM would like to thank Pr JV de Melo (University of Adelaide, Australia) for critical reading of the manuscript.

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Author notes

  1. A Nagler and M Mohty: The last two senior authors contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

    R Vrhovac

  2. AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France

    M Labopin & M Mohty

  3. Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, Paris, France

    M Labopin & M Mohty

  4. INSERM, UMR_S 938, CDR Saint-Antoine, Paris, France

    M Labopin & M Mohty

  5. EBMT ALWP Office, Hospital Saint Antoine, Paris, France

    M Labopin, A Nagler & M Mohty

  6. Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milano, Italy

    F Ciceri

  7. Medicine, Hematology and Oncology, University of Freiburg, Freiburg, Germany

    J Finke

  8. Hematology and Oncology, University of Regensburg, Regensburg, Germany

    E Holler

  9. Department of Internal Medicine III, Ludwig-Maximilians University Hospital of Munich-Grosshadern, Hematopoietic cell Transplantation, Munich, Germany

    J Tischer

  10. Hematology, Oncology and Bone Marrow Transplantation, CHU Hautepierre, Strasbourg, France

    B Lioure

  11. St Bartholomew's and The Royal London NHS Trust, London, UK

    J Gribben

  12. Department of Medicine, Tübingen University, Tübingen, Germany

    L Kanz

  13. Transplantation and Cellular Therapy, Institut Paoli Calmettes, Marseille, France

    D Blaise

  14. Department of Medicine V, University of Heidelberg, Heidelberg, Germany

    P Dreger

  15. Internal Medicine, BMT Unit, University of Saarland, Homburg, Germany

    G Held

  16. Hematology and Oncology, Charite, Universitaetsmedizin, Berlin, Germany

    R Arnold

  17. Chaim Sheba Medical Center, Tel-Hashomer, Israel

    A Nagler

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on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

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Correspondence to R Vrhovac.

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Vrhovac, R., Labopin, M., Ciceri, F. et al. Second reduced intensity conditioning allogeneic transplant as a rescue strategy for acute leukaemia patients who relapse after an initial RIC allogeneic transplantation: analysis of risk factors and treatment outcomes. Bone Marrow Transplant 51, 186–193 (2016). https://doi.org/10.1038/bmt.2015.221

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