Second hematopoietic stem cell transplantation with a new haploid-mismatched donor in relapsed patients after first transplantation: prognostic analysis of 11 cases

Abstract

Objective To investigate the clinical outcome of the patients with hematologic malignancy recurrence following first allogenetic hematopoietic stem cell transplantation (allo-HSCT) and receiving second transplantation from an alternative haploid-mismatched donor. Methods We retrospectively reported the clinical data of 11 patients with hematologic malignancies who underwent a second HSCT using a new haploidentical related donor (HRD) in our center between October 2013 and June 2021. At the second transplantation, all patients were in complete remission (CR). Six of them received donor lymphocyte infusion (DLI) after the second transplantation. The clinical prognosis of the patients was followed up to primarily explore the effect of secondary transplantation. Results The median follow-up was 9.4 (2.9~94.9) months. Of the 11 relapsed patients, 3 patients died of disease relapse and 1 patient died of lung infection, and the remaining 7 patients survived with CR. The 1-year overall survival (OS) rate was 77.9% (95%CI: 54.6%~ 99.9%), so was 1-year leukemia-free survival (LFS) rate. For the 6 patients receiving DLI, the 1-year OS rate was 83.3% (95%CI: 58.3%~99.9%). The cumulative incidence of relapse was 22.1% in the 11 patients. Conclusion A second HSCT using a new haploid-mismatched donor is a feasible strategy for the patients with hematologic malignancy recurrence after the first transplantation. It has no significant increase in treatment-related death, and shows a certain safety.

Keywords

• second stem cell transplantation
• donor lymphocyte infusion
• hematologic malignancies
• relapse