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Blood Cancer J. 2019 Nov 18;9(12):88. doi: 10.1038/s41408-019-0251-3.

Donor selection for a second allogeneic stem cell transplantation in AML patients relapsing after a first transplant: a study of the Acute Leukemia Working Party of EBMT.

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Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.
Acute Leukemia Working Party of EBMT, Paris, France.
Department of Medicine, Hematology-Oncology, University of Freiburg, Freiburg, Germany.
Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Service d'Hématologie, Hopital Jean Minjoz, Besancon, France.
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Stem Cell Transplantation & Immunotherapy, 2nd Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Internal Medicine A, University of Muenster, Muenster, Germany.
Department of Hematology, Institut Paoli Calmettes, Marseille, France.
Department of Hematology/Oncology, Medical Clinic and Policlinic, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany.
Clinical Hematology, Nantes University Hospital, Nantes, France.
Department of Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.
Department of Hematology, CHU Lapeyronie, Montpellier, France.
Department of Haematology, Saint Antoine Hospital, Paris, France.
Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.


Second allogeneic stem-cell transplantation (SCT2) is a therapeutic option for patients with AML relapsing after a first transplant. Prior studies have shown similar results after SCT2 from the same or different donor; however, there are limited data on second non-T-depleted haplo-identical transplant in this setting. We retrospectively analyzed SCT2 outcomes in 556 patients, median age 46 years, relapsing after first transplant given in CR1. Patients were divided into three groups based on SCT2 donor (donor2): same donor (n = 163, sib/sib-112, UD/UD-51), different matched donor (n = 305, sib/different sib-44, sib/UD-93, UD/different UD-168), or haplo-donor (n = 88, sib/haplo-45, UD/haplo-43). Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively (P = 0.30). Multivariate analysis showed no effect of donor2 type on relapse: hazard ratio (HR) 0.89 (P = 0.57) and 1.11 (P = 0.68) for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 (P = 0.50) and 2.08 (P = 0.03), respectively, and for LFS: HR 1.00 (P = 0.97) and 1.43 (P = 0.07), respectively. In conclusion, SCT2 with the same or different matched donor is associated with similar outcomes in patients with relapsed AML. Non-T-depleted haplo-identical transplant may be associated with higher NRM, similar relapse rate and with no better results in this setting.

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