Salvage haploidentical transplantation using low-dose ATG for early disease relapse after first allogeneic transplantation: A retrospective single-center review

Sachiyo Okamoto, Ken-ichi Matsuoka, Maiko Sakamoto, Yoshiaki Usui, Yuki Fujiwara, Takumi Kondo, Katsuma Tani, Kyosuke Saeki, Yusuke Meguri, Noboru Asada, Daisuke Ennishi, Hisakazu Nishimori, Keiko Fujii, Nobuharu Fujii, Yoshinobu Maeda

Research output: Contribution to journalArticle

Abstract

Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5% and 23.9%. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT.

Original languageEnglish
Pages (from-to)161-171
Number of pages11
JournalActa medica Okayama
Volume73
Issue number2
Publication statusPublished - Jan 1 2019

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Salvaging
Antilymphocyte Serum
Homologous Transplantation
HLA Antigens
Stem cells
Blood
Transplantation
Transplantation (surgical)
Recurrence
Grafts
Disease-Free Survival
Bone
Stem Cell Transplantation
Tissue Donors
Survival
Cell Transplantation
Graft vs Host Disease
Fetal Blood
Comorbidity
Multivariate Analysis

Keywords

  • Allogeneic stem cell transplantation
  • Anti-T lymphocyte globulin
  • Haploidentical stem cell transplantation
  • Relapse

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

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title = "Salvage haploidentical transplantation using low-dose ATG for early disease relapse after first allogeneic transplantation: A retrospective single-center review",
abstract = "Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5{\%} and 23.9{\%}. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT.",
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author = "Sachiyo Okamoto and Ken-ichi Matsuoka and Maiko Sakamoto and Yoshiaki Usui and Yuki Fujiwara and Takumi Kondo and Katsuma Tani and Kyosuke Saeki and Yusuke Meguri and Noboru Asada and Daisuke Ennishi and Hisakazu Nishimori and Keiko Fujii and Nobuharu Fujii and Yoshinobu Maeda",
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T1 - Salvage haploidentical transplantation using low-dose ATG for early disease relapse after first allogeneic transplantation

T2 - A retrospective single-center review

AU - Okamoto, Sachiyo

AU - Matsuoka, Ken-ichi

AU - Sakamoto, Maiko

AU - Usui, Yoshiaki

AU - Fujiwara, Yuki

AU - Kondo, Takumi

AU - Tani, Katsuma

AU - Saeki, Kyosuke

AU - Meguri, Yusuke

AU - Asada, Noboru

AU - Ennishi, Daisuke

AU - Nishimori, Hisakazu

AU - Fujii, Keiko

AU - Fujii, Nobuharu

AU - Maeda, Yoshinobu

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5% and 23.9%. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT.

AB - Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5% and 23.9%. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT.

KW - Allogeneic stem cell transplantation

KW - Anti-T lymphocyte globulin

KW - Haploidentical stem cell transplantation

KW - Relapse

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