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Ruutu (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract68
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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A second allogeneic hematopoietic stem cell transplantation for relapse of malignant disease: Outcome and predictive factors

Tapani Ruutu on behalf of the European Group for Blood and Marrow Transplantation and the European LeukemiaNet

Department of Medicine, Division of Haematology, Helsinki University Central Hospital, Helsinki Finland

Correspondence: Tapani Ruutu, Department of Medicine, Division of Haematology, Helsinki University Central Hospital, Biomedicum 2 C, POB 705, Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland, E-mail: tapani.ruutu@spam is badhus.fi

Abstract

The role of a second allogeneic stem cell transplantation after a relapse of malignant disease after the first transplantation is not clear. To study the outcome and predictive factors in second transplantations, a retrospective analysis of all second allogeneic transplantations carried out for a relapse of malignant disease after the first transplantation at the centers of the European Group for Blood and Marrow Transplantation (EBMT) between 1994 and 2005 and reported to the EBMT registry (n=1633) was made. The overall survival in the entire group of patients was 39% at one year, 29% at 2 years, and 21% at 5 years. The respective figures for non-relapse death were 31, 35 and 37%. In multivariate analysis, factors significantly associated with better survival were disease, longer interval between first and second transplantation, younger age, and state of the disease. Factors showing no association with overall survival were the occurrence of GvHD after the first transplantation, duration of remission after the first transplantation, conditioning at the second transplantation or any combination of conditioning intensity in the two transplantations (MAC–RIC), type of donor, and whether the donor was the same as in the first transplantation or not. The main cause of death was relapse or disease progression in 52% and transplantation-related (non-relapse) in 48%. There were no differences between disease groups in non-relapse mortality. At 5 years, the overall survival was 15% in acute leukemias, 18% in MDS or MPD, and 40% in chronic leukemias. In conclusion, overall the results of second allogeneic transplantations for relapse of malignant disease are rather poor but patient groups with quite favorable outcomes can be identified.

Keywords: hematopoietic stem cell transplantation, bone marrow transplantation, second transplantation, relapse, outcome, predictive factors

 

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