Maximilian Christopeit and Oliver Kuss, University of Halle, Halle (Saale); Jürgen Finke and Hartmut Bertz, University Hospital Freiburg, Freiburg; Ulrike Bacher and Nicolaus Kröger, Bone Marrow Transplantation Centre, University Hospital Hamburg-Eppendorf, Hamburg; Ulrike Bacher, Munich Leukaemia Laboratory; Johanna Tischer, Ludwig Maximilian University Hospital; Hans-Jochem Kolb, Technical University Hospital, Munich; Christoph Schmid, Augsburg Medical Hospital, Ludwig Maximilian University of Munich, Augsburg; Dietrich Wilhelm Beelen, University Hospital Essen, Essen; Martin Bornhäuser, University Hospital Dresden, Dresden; Rainer Schwerdtfeger, Deutsche Klinik für Diagnostik, Wiesbaden; Wolfgang Andreas Bethge, University Hospital Tübingen, Tübingen; Nadezda Basara and Dietger Niederwieser, University Hospital Leipzig, Leipzig; Martin Gramatzki, University Hospital Kiel, Kiel; Lutz Uharek, Charité-Campus B. Franklin, University Hospital Berlin, Berlin; Ralf G. Meyer, University Medical Center Mainz, Mainz; Donald Bunjes, University Hospital Ulm; Hubert Schrezenmeier, Deutsches Register für Stammzelltransplantation and Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University of Ulm, Ulm; Christof Scheid, University Hospital Cologne, Cologne; and Hans Martin, University Hospital Frankfurt, Frankfurt, Germany.
J Clin Oncol. 2013 Sep 10;31(26):3259-71. doi: 10.1200/JCO.2012.44.7961. Epub 2013 Aug 5.
To evaluate the role of a second allogeneic hematopoietic stem-cell transplantation (HSCT2) given for relapsed acute leukemia (AL) after related or unrelated first hematopoietic stem-cell transplantation (HSCT1) and to analyze the role of donor change for HSCT2 in both settings.
We performed a retrospective registry study on 179 HSCT2s given for relapse after HSCT1 from matched related donors (n = 75) or unrelated donors (n = 104), using identical or alternative donors for HSCT2. Separate analyses were performed according to donor at HSCT1.
Independent of donor, 74% of patients achieved complete remission after HSCT2, and half of these patients experienced relapse again. Overall survival (OS) at 2 years was 25% ± 4% (39% ± 7% after related HSCT2; 19% ± 4% after unrelated HSCT2). Long-term survivors were observed even after two unrelated HSCT2s. Multivariate analysis for OS from HSCT2 confirmed established risk factors (remission duration after HSCT1: hazard ratio [HR], 2.37; 95% CI, 1.61 to 3.46; P < .001; stage at HSCT2: HR, 0.53; 95% CI, 0.34 to 0.83; P = .006). Outcome of HSCT2 was better after related HSCT1 than after unrelated HSCT1 (2-year OS: 37% ± 6% v 16% ± 4%, respectively; HR, 0.68; 95% CI, 0.47 to 0.98; P = .042, multivariate Cox regression). After both related and unrelated HSCT1, selecting a new donor for HSCT2 did not result in a relevant improvement in OS compared with HSCT2 from the original donor; however, donor change was not detrimental either.
After relapse from allogeneic HSCT1, HSCT2 can induce 2-year OS in approximately 25% of patients. Unrelated HSCT2 is feasible after related and unrelated HSCT1. Donor change for HSCT2 is a valid option. However, a clear advantage in terms of OS could not be demonstrated.
评估在同胞或非血缘造血干细胞移植（HSCT）1 后复发的急性白血病（AL）接受第二次异基因 HSCT（HSCT2）的作用，并分析在这两种情况下供者改变对 HSCT2 的作用。
我们对 179 例同胞或非血缘 HSCT1 后复发患者进行了回顾性注册研究，他们接受了第二次异基因 HSCT2，供者分别为匹配的同胞（n=75）或非血缘（n=104），第二次 HSCT2 采用了相同或不同的供者。根据 HSCT1 时的供者，分别进行了单独分析。
独立于供者，74%的患者在 HSCT2 后获得完全缓解，其中一半的患者再次复发。2 年总生存率（OS）为 25%±4%（同胞 HSCT2 后为 39%±7%；非血缘 HSCT2 后为 19%±4%）。即使接受了两次非血缘 HSCT2，也观察到了长期生存者。多因素分析显示，HSCT2 的 OS 与以下因素相关：HSCT1 后缓解持续时间（危险比[HR]，2.37；95%可信区间[CI]，1.61 至 3.46；P<0.001）；HSCT2 时的分期（HR，0.53；95%CI，0.34 至 0.83；P=0.006）。同胞 HSCT1 后 HSCT2 的结果优于非血缘 HSCT1 后 HSCT2（2 年 OS：分别为 37%±6%和 16%±4%；HR，0.68；95%CI，0.47 至 0.98；P=0.042，多因素 Cox 回归）。在同胞和非血缘 HSCT1 后，与原始供者 HSCT2 相比，为 HSCT2 选择新供者并未显著改善 OS；然而，供者改变也没有造成损害。
在同胞或非血缘 HSCT1 后复发后，HSCT2 可使约 25%的患者在 2 年内获得 OS。同胞 HSCT2 后和非血缘 HSCT1 后可行非血缘 HSCT2。HSCT2 的供者改变是一种可行的选择。然而，在 OS 方面并未显示出明显的优势。
