C. Martinez et al., Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution, LEUK RES, 25(5), 2001, pp. 379-384
The prognosis of patients relapsing after an autologous transplant (autoSCT
) is very poor. Allogenic stem cell transplantation (alloSCT) offers the po
ssibility of curing some of these patients, at the cost, however, of a high
transplant related mortality (TRM). The aim of this study was to analyze t
he outcome of 14 consecutive patients with hematologic malignancies, from a
single institution, who underwent alloSCT for progressive disease after au
toSCT. Patients had relapsed at a median of 11.5 months (range 2-72) after
autoSCT and they underwent alloSCT at a median of 25.5 months (range 7-73)
from the first transplant. Ten patients received HLA-identical related peri
pheral blood progenitor cells, three patients underwent matched-unrelated d
onor marrow transplants, and one patient received a mismatched related tran
splant. Conditioning regimens consisted of total body irradiation plus cycl
ophosphamide (n = 5) or melphalan (n = 1), or high-dose combination chemoth
erapy (n = 8). Cyclosporin A and methothrexate were administered as graft-v
ersus-host disease (GVHD) prophylaxis. Eight patients (57%) developed grade
II-IV acute GVHD. All evaluable patients (n = 6) presented extensive chron
ic GVHD. Overall survival at 1 year was 16% (median 3.5 months, 95% CI 0.7-
10.3). Ten patients (71%) died from transplant related complications at a m
edian of 3.5 months (range 0.7-11). Only one patient died of recurrent dise
ase. Three patients remain alive and in complete remission at the time of t
his report (4, 20 and 20 months, respectively). In conclusion, alloSCT offe
rs the possibility of a sustained control of the disease in some patients w
ho relapse after an autoSCT. However, the procedure is associated with a hi
gh transplant-related mortality. Better results might be obtained by carefu
lly selecting patients and by reducing the intensity of the preparative reg
imen. (C) 2001 Elsevier Science Ltd. AII rights reserved.