@article{703602576d8745a09a97ca037fd756bd,
title = "Long-Term Survival and Late Effects among One-Year Survivors of Second Allogeneic Hematopoietic Cell Transplantation for Relapsed Acute Leukemia and Myelodysplastic Syndromes",
abstract = "We analyzed the outcomes of patients who survived disease-free for 1 year or more after a second allogeneic hematopoietic cell transplantation (HCT) for relapsed acute leukemia or myelodysplastic syndromes between 1980 and 2009. A total of 1285 patients received a second allogeneic transplant after disease relapse; among these, 325 were relapse free at 1 year after the second HCT. The median time from first to second HCT was 17 and 24 months for children and adults, respectively. A myeloablative preparative regimen was used in the second transplantation in 62% of children and 45% of adult patients. The overall 10-year conditional survival rates after second transplantation in this cohort of patients who had survived disease-free for at least 1 year was 55% in children and 39% in adults. Relapse was the leading cause of mortality (77% and 54% of deaths in children and adults, respectively). In multivariate analyses, only disease status before second HCT was significantly associated with higher risk for overall mortality (hazard ratio, 1.71 for patients with disease not in complete remission before second HCT, P < .01). Chronic graft-versus-host disease (GVHD) developed in 43% and 75% of children and adults after second transplantation. Chronic GVHD was the leading cause of nonrelapse mortality, followed by organ failure and infection. The cumulative incidence of developing at least 1 of the studied late effects within 10 years after second HCT was 63% in children and 55% in adults. The most frequent late effects in children were growth disturbance (10-year cumulative incidence, 22%) and cataracts (20%); in adults they were cataracts (20%) and avascular necrosis (13%). Among patients with acute leukemia and myelodysplastic syndromes who receive a second allogeneic HCT for relapse and survive disease free for at least 1 year, many can be expected to survive long term. However, they continue to be at risk for relapse and nonrelapse morbidity and mortality. Novel approaches are needed to minimize relapse risk and long-term transplantation morbidity in this population.",
keywords = "Allogeneic transplantation, Hematopoietic cell transplantation, Late effects, Long-term survival, Second transplantation",
author = "Duncan, {Christine N.} and Majhail, {Navneet S.} and Ruta Brazauskas and Zhiwei Wang and Cahn, {Jean Yves} and Frangoul, {Haydar A.} and Hayashi, {Robert J.} and Hsu, {Jack W.} and Kamble, {Rammurti T.} and Kasow, {Kimberly A.} and Nandita Khera and Lazarus, {Hillard M.} and Loren, {Alison W.} and Marks, {David I.} and Maziarz, {Richard T.} and Paulette Mehta and Myers, {Kasiani C.} and Maxim Norkin and Pidala, {Joseph A.} and Porter, {David L.} and Vijay Reddy and Wael Saber and Savani, {Bipin N.} and Schouten, {Harry C.} and Amir Steinberg and Wall, {Donna A.} and Warwick, {Anne B.} and Wood, {William A.} and Yu, {Lolie C.} and Jacobsohn, {David A.} and Sorror, {Mohamed L.}",
note = "Funding Information: CIBMTR funding support: CIBMTR is supported by Public Health Service grant/cooperative agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a grant/cooperative agreement 5U01HL069294 from NHLBI and NCI ; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); 2 grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research ; and grants from Allos, Inc. ; Amgen, Inc. ; Angioblast ; anonymous donation to the Medical College of Wisconsin ; Ariad ; Be The Match Foundation ; Blue Cross and Blue Shield Association ; Buchanan Family Foundation ; CaridianBCT ; Celgene Corporation ; CellGenix , GmbH ; Children's Leukemia Research Association ; Fresenius-Biotech North America, Inc. ; Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; Genzyme Corporation ; GlaxoSmithKline ; HistoGenetics, Inc. ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin ; Merck & Co., Inc. ; Millennium: The Takeda Oncology Co. ; Milliman USA, Inc. ; Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; RemedyMD ; Sanofi ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; StemCyte, A Global Cord Blood Therapeutics Co. ; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; Tarix Pharmaceuticals ; Teva Neuroscience, Inc. ; THERAKOS, Inc. ; and WellPoint , Inc. . The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government. Publisher Copyright: {\textcopyright} 2015 American Society for Blood and Marrow Transplantation.",
year = "2015",
month = jan,
day = "1",
doi = "10.1016/j.bbmt.2014.10.006",
language = "English",
volume = "21",
pages = "151--158",
journal = "Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation",
issn = "1083-8791",
number = "1",
}