Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft

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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 cyclospodne (CyA) + methotrexate (MTX). Results. Acute GvHD was scored as 0-1, 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.

Original languageEnglish
Pages (from-to)646-651
Number of pages6
JournalHaematologica
Volume86
Issue number6
Publication statusPublished - 2001

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Autografts
Hematopoietic Stem Cells
Tissue Donors
Transplants
Recurrence
Graft vs Host Disease
Cyclophosphamide
Allografts
Thiotepa
Unrelated Donors
Mortality
Autologous Transplantation
Whole-Body Irradiation
Hematologic Neoplasms
Bone Marrow Transplantation
Methotrexate
Disease-Free Survival
Siblings
Neoplasms
Intercellular Signaling Peptides and Proteins

Keywords

  • Allogeneic transplantation
  • Autologous transplantation
  • Relapse

ASJC Scopus subject areas

  • Hematology

Cite this

@article{0ec6c9ae651c43438056e03b220e1344,
title = "Conventional hematopoietic stem cell transplants from identical or alternative donors are feasible in recipients relapsing after an autograft",
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 cyclospodne (CyA) + methotrexate (MTX). Results. Acute GvHD was scored as 0-1, 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.",
keywords = "Allogeneic transplantation, Autologous transplantation, Relapse",
author = "{Di Grazia}, C. and Raiola, {A. M.} and {Van Lint}, {M. T.} and T. Lamparelli and F. Gualandi and G. Berisso and S. Bregante and A. Dominietto and N. Mordini and B. Bruno and F. Frassoni and A. Bacigalupo",
year = "2001",
language = "English",
volume = "86",
pages = "646--651",
journal = "Haematologica",
issn = "0390-6078",
publisher = "NLM (Medline)",
number = "6",

}

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

Y1 - 2001

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 cyclospodne (CyA) + methotrexate (MTX). Results. Acute GvHD was scored as 0-1, 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.

AB - 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 cyclospodne (CyA) + methotrexate (MTX). Results. Acute GvHD was scored as 0-1, 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.

KW - Allogeneic transplantation

KW - Autologous transplantation

KW - Relapse

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M3 - Article

C2 - 11418375

AN - SCOPUS:0034961059

VL - 86

SP - 646

EP - 651

JO - Haematologica

JF - Haematologica

SN - 0390-6078

IS - 6

ER -