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Second allogeneic stem cell transplantation (alloSCT) offers improved survival for relapsed hematologic malignancies. Current data support wider use, identifying key risk factors for non-relapse mortality (NRM) to guide patient selection.

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Area of Science:

  • Hematology
  • Oncology
  • Transplantation Immunology

Background:

  • Lack of consensus exists regarding indications for second allogeneic stem cell transplantation (alloSCT) in patients with hematologic malignancies relapsing after initial alloSCT.
  • Historical data reported high non-relapse mortality (NRM), discouraging repeat alloSCT.

Purpose of the Study:

  • To analyze the outcomes of second alloSCT in patients with relapsed hematologic malignancies.
  • To identify risk factors associated with NRM and survival after second alloSCT.

Main Methods:

  • Retrospective analysis of 3356 patients undergoing second alloSCT for hematologic malignancy relapse between 2011 and 2021.
  • Evaluation of NRM, relapse incidence, overall survival (OS), and progression-free survival (PFS) at two years post-transplant.
  • Multivariate analysis to identify key risk factors for outcomes.

Main Results:

  • Two-year outcomes included: NRM 22%, relapse incidence 50%, OS 38%, and PFS 28%.
  • Significant risk factors for increased NRM were older age, low performance score, high disease-risk-index, early relapse post-first alloSCT, unrelated/haploidentical donor, and prior GVHD.
  • Graft-versus-host disease (GVHD) after the first alloSCT was a risk factor for GVHD post-second alloSCT.

Conclusions:

  • Outcomes for second alloSCT have considerably improved compared to historical reports.
  • Current data support broader utilization of second alloSCT for relapsed hematologic malignancies.
  • Identification of NRM risk factors can aid in patient selection and management for second alloSCT.