ASH evidence-based guidelines: is there a role for second allogeneic transplant after relapse?

Area of Science:

• Hematology
• Oncology
• Transplant Immunology

Background:

• Relapsed FLT3(+) acute myeloid leukemia (AML) after allogeneic stem cell transplant (SCT) presents a therapeutic challenge.
• Graft-versus-host disease (GVHD) and its management can impact long-term outcomes post-SCT.
• Disease relapse while off immunosuppression raises questions about the optimal timing and strategy for further treatment.

Purpose of the Study:

• To discuss the therapeutic considerations for a second allogeneic SCT in a patient with relapsed FLT3(+) AML post-initial SCT.
• To evaluate the potential role, timing, conditioning regimens, and donor selection for salvage SCT.

Main Methods:

• Case report of a 35-year-old male with FLT3(+) AML.
• Underwent myeloablative, non-TBI conditioning allogeneic peripheral blood SCT from an HLA-matched sibling.
• Managed acute GVHD and monitored for relapse post-immunosuppression withdrawal.

Main Results:

• The patient developed grade II acute GVHD, which resolved with immunosuppression.
• No chronic GVHD was observed after medication discontinuation.
• Eighteen months post-transplant, the patient relapsed with circulating blasts while off immunosuppression.

Conclusions:

• Relapse of FLT3(+) AML after a first allogeneic SCT necessitates careful consideration of salvage treatment options.
• The potential role and optimal strategy for a second allogeneic SCT, including donor source and conditioning, require further investigation in such cases.