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Long-Term Survival and Late Effects Among 1-Year Survivors of Second Allogeneic Hematopoietic Cell Transplantation (2nd Allo HCT) for Relapsed Acute Leukemia and Myelodysplastic Syndrome: A Report from the Cibmtr

Track: BMT Tandem "Scientific" Meeting
Saturday, March 1, 2014, 4:45 PM-6:45 PM
Texas C (Gaylord Texan)
Christine Duncan, MD , Dana-Farber Cancer Institute, Boston, MA
Navneet S. Majhail, MD, MS , Blood and Marrow Transplant Program, Cleveland Clinic Foundation, Cleveland, OH
Ruta Brazauskas, PhD , Biostatistics, Medical College of Wisconsin, Milwaukee, WI
Zhiwei Wang, MS , CIBMTR, The Medical College of Wisconsin, Milwaukee, WI
Jean-Yves Cahn, MD , University Hospital, Grenoble, France
Rammurti T. Kamble, MD , Baylor College of Medicine Center for Cell and Gene Therapy, Houston, TX
Haydar A. Frangoul, MD , Vanderbilt University Medical Center, Nashville, TN
Robert J. Hayashi, MD , St. Louis Children's Hospital, University of Washington, St. Louis, MO
Jack W. Hsu, MD , University of Florida, Gainesville, FL
David A. Jacobsohn, Chief, Division of Blood and Marrow Transplantation , Children's National Medical Center, Washington, DC
Kimberly A. Kasow, DO , University of North Carolina, Chapel Hill, NC
Nandita Khera, MD , Blood and Marrow Transplant, Mayo Clinic, Phoenix, AZ
Hillard M. Lazarus, MD , University Hospitals Case Medical Center, Cleveland, OH
Allison W. Loren, MD, MS , Abramson Cancer Center University of Pennsylvania Medical Center, Philadelphia, PA
Richard T. Maziarz, MD , Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
Paulette Mehta, MD, MPH , University of Arkansas for Medical Sciences, Little Rock, AR
Kasiani C. Myers, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Joseph Pidala, MD, MS , H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
David L. Porter, MD , Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Vijay Reddy, MD, PhD , University of Florida, Gainesville, FL
Wael Saber, MD, MS , CIBMTR, Medical College of Wisconsin, Milwaukee, WI
Harry C. Schouten, MD, PhD , Academische Ziekenhuis Maastricht, Maastricht, Netherlands
Amir Steinberg, MD , Mount Sinai Medical Center, Los Angeles, CA
Lolie C Yu, MD , Children's Hospital, NewOrleans, LA
Donna A. Wall, MD , CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
Anne B. Warwick, MD, MPH , Uniformed Services University, Bethesda, MD
William A. Wood, MD, MPH , University of North Carolina Hospitals, Chapel Hill, NC
Bipin N. Savani, MD , Vanderbilt University Medical Center, Nashville, TN
Mohamed L. Sorror, MD, MSc , Fred Hutchinson Cancer Research Center, Seattle, WA
Audio File Recorded Presentation

Little is known about long-term outcomes in survivors of 2nd allo HCT performed for patients who have relapsed following a previous allo HCT. We analyzed outcomes of 1-year survivors following 2nd allo HCT who were reported to the CIBMTR between 1980 and 2009. Overall, 1285 patients received a 2nd HCT for relapsed acute leukemia or myelodysplastic syndromes; 325 1-year survivors were eligible for this study (children=146, adults=179). Rate of 1-year survival was 35% for all pts. The corresponding rates for children and adults were 30% and 46%. The majority of grafts (61%) used the same donor for the 2nd transplant. The median age at 2nd HCT was 9 (range: 1- 17) years and 38 (range 19-66) years for children and adults, respectively. Myeloablative (MA) regimen was used in 89% for 1st and 62% for 2nd HCT in children and in 79% and 45% of adults. 16% children and 32% adults had a history of chronic GVHD prior to 2nd HCT. In the two age groups, median time from 1st HCT to relapse was 14 mos and 18 mos, and median time from 1st to 2nd HCT was 17 mos and 24 mos, respectively. The Table shows the conditional probability of 10-year outcomes. Chronic GVHD developed in 43% and 75% children and adults following 2nd HCT.  Relapse was the major cause of death (43/56 for children and 54/96 for adults, respectively). In proportional hazard models, only disease status (relapse/progression) prior to second HCT was associated with statistically significant higher risk for mortality (HR 1.71 (95% CI 1.22-2.38) vs. remission; P<0.01). Other pre-transplant characteristics had no impact on survival including age, interval between 1st and 2nd HCT, chronic GVHD, 1st-2nd HCT donor pair, or conditioning intensity for 2nd HCT. The CIBMTR collects information on selected late complications. The cumulative incidence of developing at least one late effect for which data were collected at 10-years following 2nd HCT was 63% in children and 55% in adults. In children, notable late effects were growth disturbance (10-year cumulative incidence after 2nd HCT 22%), cataracts (20%), gonadal dysfunction (16%), and hypothyroidism (13%). In adults, cataracts (20%), avascular necrosis (13%) and hypothyroidism (5%) were commonly reported late effects after 2nd HCT. In summary, 1-year survivors of 2nd allo HCT for relapsed acute leukemia or MDS have favorable long-term outcomes. Attaining remission prior to HCT is the single favorable predictive factor for long-term survival. Majority of late failures are due to relapse and late effects are frequently encountered. Future trials focusing on reducing risks of relapse and implementing systematic surveillance for long-term toxicities are warranted.

 

 

Table: Conditional probability of 10-yr outcomes in 1-year 2nd allo HCT survivors with relapsed leukemia and MDS

 

 

Children

% (95% CI)

Adults

% (95% CI)

Overall survival

55 (44-65)

39 (31-48)

Non-relapse mortality

10 (5-17)

34 (26-42)

Relapse

34 (26-43)

32 (24-40)

 

Disclosures:
Nothing To Disclose
See more of: Oral Abstracts - Session J - Late Effects/Quality of Life & Supportive Care
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