Second allogeneic hematopoietic stem cell transplantation in treatment of relapsed acute myeloid leukemia: clinical report of 5 cases

Abstract

Objective To investigate the clinical efficacy and its influencing factors of second allogeneic hematopoietic stem cell transplantation (allo-HSCT2) in acute myeloid leukemia (AML) patients who have relapsed after the first allogeneic transplantation. Methods Clinical data of 5 patients with refractory/relapsed AML who had relapsed after allo-HSCT in our medical center from January 2012 to October 2018 were collected in this study. After re-induction (CR2-MRD- was achieved in 3 cases, CR2-MRD+ in 1 case, and NR in 1 case) and myeloablative pretreatment, allo-HSCT2 was conducted to all of them. The clinical process and outcome of these cases were analyzed, and the possible effects of alleviation status, donor selection, pretreatment protocol of the allo-HSCT2 patients before transplantation on the complications, recurrence and death (RM), transplant-related mortality (TRM), and transplantation outcome were also investigated. Results Until the 5 patients were followed up to June 30, 2019, all of them achieved complete donor implantation. Three of them had no relapse within 17 months, and 1 patient developed acute graft versus host disease (aGVHD) grade Ⅰ and chronic graft versus host disease (cGVHD) as severe lung disease, and hence deceased due to respiratory failure in 20 months after the allo-HSCT2. No serious HSCT-related complications were observed in the other 4 patients. The patients with complete remission of allo-HSCT2 with a negative status of (minimal residual disease, MRD), proved to have a better prognosis. Second allo-HSCT did not increase TRM compared with one-time allo-HSCT. For the patients receiving allo-HSCT2, the GVL effect of haploid transplantation had no significant advantage against full-matched HSCT. Conclusion Allo-HSCT2 is an effective therapy for AML patients who relapsed after the first allo-HSCT.

Keywords

• acute myeloid leukemia
• relapse
• second transplantation
• allogenic hematopoietic stem cell transplantation