282 Outcomes After Second Allogeneic Transplants in Pediatric Patients with Relapsed Hematological Malignancies

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Swati Naik , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Caridad Martinez, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Catherine M. Bollard, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Javier Amin El-Bietar, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Stephen Gottschalk, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Kathryn Leung, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Carl Allen, MD, PhD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Nabil M Ahmed, MD, MPH , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Helen E Heslop, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Malcolm K. Brenner, MD, PhD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Robert A. Krance, MD , Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
Recurrence of hematological malignancies is one of the most common indications for a second hemotopoeitic stem cell transplant (HSCT). However there are limited outcomes data after second HSCT in pediatric patients. We report the results of second HSCT in 42 patients with relapsed lymphoid (n-12) or myeloid (n-30) malignancies after first HSCT performed at our institution between 2000-2012. The median age at the time of the second transplant was 7 years (range: 2-19 years). 20/42 patients had active disease at the time of second transplant. The median time to relapse after a first transplant was 242 days (range: 138d-731d) for lymphoid malignancies and 202.5days (range: 50d-1687d) for myeloid malignancies. 20/42 received a haplo-identical donor (haplo), 19/42 received a matched or mismatched unrelated donor (MUD/MMUD) and 3/42 received a matched or mismatched related donor (MRD/MMRD). 16 patients had myeloablative conditioning and 26 reduced intensity conditioning.  Overall survival and disease free survival (DFS) were 30% (13/42) and 26% (11/42), respectively with a median follow up of 1496 days (range: 37d-3434d).  5/16 of these survivors had received myeloablative conditioning versus 6/26 who received reduced intensity conditioning.  The DFS by disease type was 16% (2/12) for lymphoid and 30% (9/30) for myeloid malignancies (MDS/AML, n=6/10; AML, n=2/17; biphenotypic, n=1/1), respectively.  Patients with MDS/AML had better outcome than patients with AML alone. Survival also varied according to donor type (7/20 haplo, 4/19 MUD/MMUD, and 0/3 MRD/MMRD). Of the 11 disease free survivors, 8 were in remission at the time of the second transplant and 9 had relapsed >240 days post transplant. Overall median survival was 4.6 years (range: 0.2-9.7 years). The primary cause of death was relapse/persistent disease in 24/42 or infection/ GVHD in 7/42.   Additionally, 7 of these patients underwent a third HSCT for relapsed disease after second HSCT and all 7 had active disease at time of third transplant. No patients survived after a third transplant. Hence 26% of relapsed patients may be long term disease free survivors after a second HSCT from a haploidentical or unrelated donor.  Patients transplanted in full remission with relapse >240 days after first HSCT and a diagnosis of MDS/AML are likely to be favorable prognostic factors.
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