12/16/2023 0 Comments Allogeneic stem cell transplant![]() We have employed in vivo T-cell depletion with alemtuzumab for over a decade at the University of Chicago and confirmed lower rates of acute and chronic GVHD with similar overall survival to T cell repleted HCT. T-cell depletion is an approach that enhances procedure tolerability by reducing acute and chronic GVHD related morbidity and mortality. Long-term survival was only achieved in patients who achieved CR by cyto-reductive therapy, followed either by donor lymphocyte infusion or second HCT as consolidation. In addition, a recent retrospective registry study performed by the Acute Leukemia Working Party of EBMT reported the outcomes of adults with relapsed AML after RIC HCT. Second HCT has been demonstrated repeatedly to provide benefit, albeit in a small subset of patients, with larger more recent retrospective studies confirming this observation. The treatment options for disease relapse after HCT include withdrawal of immune suppression, chemotherapy, second allogeneic transplant, cytokine and adoptive cell therapy and donor lymphocyte infusion. In most situations, treatment options at relapse after HCT are very limited with unacceptably high rates of disease relapse. However, relapse after HCT remains the major cause for treatment failure. The numbers of HCT are steadily increasing worldwide, with improving outcomes as judged by lower treatment-related mortality. HCT is the only curative treatment for many high-risk hematologic diseases, including AML, and MDS. A score of 12 months after first HCT with acceptable rates of GVHD and donor engraftment. non-CR = 1), and remission duration after first HCT ( 12 months = 0) was generated as an approach to classify patients into different risk categories in the purpose to provide guidance to the transplant physician to inform the outcomes to potential patients undergoing 2nd HCT. A scoring system using disease status before second HCT (CR = 0 vs. In univariate analysis, patients with remission duration after first HCT of > 12 months and those in CR before second HCT had significantly better PFS and OS. The day 100 cumulative incidence of non-relapse mortality rate was 23.6%, and the cumulative incidence of aGVHD and cGVHD were 16.9% and 7.7% respectively at 1 year after second HCT. With a median follow up of 23 (5.5–140) months for survivors after second HCT, the estimated 2 years PFS was 17.5% and the 2 years OS was 22.6%. ![]() 98% (n = 64) and 72% (n = 47) patients achieved neutrophil and platelet engraftment at a median interval of 10 and 18 days, respectively, following the second HCT. 13 patients (20%) achieved CR before second HCT. The median age at second HCT was 45 years (11–73). The majority of patients had AML (n = 47) and high risk MDS (n = 5). ResultsĪll except four patients received T cell depleted (TCD) first HCT. Univariate and multivariate analysis were conducted, and a scoring system was generated to select the patients who would benefit second HCT. We analyzed retrospectively the outcomes of 65 consecutive patients who underwent a second HCT for disease relapse at the University of Chicago. Second allogeneic hematopoietic stem cell transplant (HCT) remains as an option for disease relapse after initial HCT.
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