Outcome of second/third allogeneic hematopoietic stem cell transplantations for a relapse of acute leukemia after the first transplantation

Abstract

Background: Although a second allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be a curative treatment for patients with acute leukemia who have relapsed after the first allo-HSCT, its disadvantages for patients may be too great given the high rate of transplantation-related morbidity and mortality. We aimed to identify the risk factors predicting early mortality after a second/third allo-HSCT. Methods: We retrospectively analyzed the medical records of patients with acute leukemia who underwent allo-HSCTs twice or more in Tenri Hospital between December 1998 and April 2012. Results: Eighteen patients, consisting of 12 with acute myeloid leukemia and 6 with acute lymphoblastic leukemia, were included. Six patients survived for >1 year, while 6 patients died within 60 days after the second allo-HSCT, and 17 patients finally died. The median overall survival time was 178 days. Concurrent infection, moderate/severe liver injury, and higher H(S)CT-specific comorbidity index (CI) score were significantly associated with mortality within 60 days. The median survival times of patients with HCT-CI scores 0, 1/2, and >3 were 335, 313, and 26 days, respectively, and the survival of the last was significantly worse than that of the former two groups. Three patients who underwent a third allo-HSCT for relapsing/refractory leukemia died within 60 days after the transplant. A total of nine patients who died <60 days after the second/third allo-HSCT developed significant morbidities of the lung, gastrointestinal tract, and central nervous system. Conclusion: Second allo-HSCT recipients with concurrent infection, moderate/severe liver injury, and higher HCT-CI scores have a greater likelihood of early mortality and are unlikely to benefit from the transplant.