Second stem cell transplant using reduced intensity conditioning for leukemia or lymphoma

This study aimed to investigate the outcomes of a second hematopoietic stem cell transplant (HSCT) after reduced-intensity conditioning (RIC) for patients with leukemia or lymphoma. 

This study concluded that this treatment path is feasible and a good alternative for these patients.  

Allogenic hemopoietic stem cell transplantation (allo-HSCT) is the transfer of stem cells from a matched donor to a cancer patient. HSCT can replace diseased blood cells destroyed by cancer treatment. HSCT can also be autologous (auto-HSCT) where the stem cells come from the patients themselves.  

Relapse and graft failure after allo- or auto-HSCT are serious and often fatal events. A second HSCT can be lifesaving but there is little information available on this.  

This study involved 27 patients with leukemia or lymphoma who received an outpatient allo-HSCT after an initial auto-HSCT (12 patients) or allo-HSCT (15 patients) which failed. Patients were treated with a second allo-HSCT after reduced-intensity conditioning (RIC) treatment.  

In the group that had a first auto-HSCT, the average follow-up was 11 months. The one-year overall survival (OS) rate was 66.7% in this group. 59.1% of the patients in this group were alive and disease-free after 1 year. 

In the group that had a first allo-HSCT, the average follow-up was 11 months. The OS rate for this group was 43.3% at one year and 36.1% were alive and disease-free at 1 year. 

Graft-versus-host disease (GVHD) is when the transplanted cells attack the patient's body. It is a complication of HSCT. In the group with a first auto-HSCT transplant, 25% had a short-term GVHD and 41.6% had a long-term GVHD after the second allo-HSCT. In the group that had a first allo-HSCT, 13.2% had short-term GVHD and 40% had long-term GVHD after the second allo-HSCT. 

A period longer than 10 months between transplants was associated with a 73% higher chance of longer survival. The occurrence of long-term GVHD after the second transplant was associated with a 74% higher chance of a longer OS.

This study concluded that a second outpatient allo-HSCT using RIC after a first auto- or allo-HSCT failure or relapse is a good option in patients with leukemia or lymphoma. 

This study included a small number of participants with different blood cancers. Also, the results were based on medical records. Information might have been missing. Further studies are needed.