Impact of Conditioning Intensity on Clinical Outcomes of Second Allogeneic Hematopoietic Cell Transplantation for Relapse After First Transplantation

Although second allogeneic hematopoietic cell transplantation HCT (HCT2) is a potentially curative treatment for patients relapsing after their first HCT (HCT1), it is associated with higher non-relapse mortality (NRM) compared with HCT1. Furthermore, while reduced-intensity conditioning (RIC) in HCT2 might decrease NRM, there is no consensus on which patients may benefit from RIC. We retrospectively analyzed 2478 patients who underwent HCT2 for relapse of hematologic malignancies after HCT1. In a multivariate analysis, older recipient age, short duration between HCT1 and HCT2, RIC in HCT1, HCT-CI ≥ 2, and ECOG PS ≥ 2 were associated with an increased risk of NRM. RIC in HCT2 was associated with better NRM compared to myeloablative conditioning (MAC) (hazard ratio [HR] 0.83, 95% confidence interval [CI]: 0.72-0.97; p = 0.018), but was not significantly associated with overall survival (OS) (HR 0.91, 95% CI: 0.82-1.01; p = 0.075). We observed a significant interaction for NRM between extensive cGVHD in HCT1 and the conditioning intensity of HCT2 (interaction p < 0.001), meaning that the benefit of RIC in HCT2 was seen in patients with extensive cGVHD in HCT1, but not in those without cGVHD. RIC in HCT2 was also associated with superior OS in patients with extensive cGVHD in HCT1 (HR 0.68, 95% CI: 0.49-0.93; p = 0.02), with significant interaction between the conditioning intensity and the prior history of extensive cGVHD (interaction p = 0.01). This study suggests that RIC in HCT2 reduces NRM for HCT2 and improves OS, especially in patients with a history of extensive cGVHD.

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Publication Details

Journal
American Journal of Hematology
Published
2025-05-23
DOI
https://doi.org/10.1002/ajh.27709
Citations
1
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
Field-Weighted Citation Impact
1.77
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article

Impact of Conditioning Intensity on Clinical Outcomes of Second Allogeneic Hematopoietic Cell Transplantation for Relapse After First Transplantation

Masatsugu Tanaka, Masaharu Tamaki, Naoyuki Uchida, Yuta Katayama et al.
1 citations
American Journal of Hematology
Hematopoietic Stem Cell Transplantation
1.77
article

Impact of Conditioning Intensity on Clinical Outcomes of Second Allogeneic Hematopoietic Cell Transplantation for Relapse After First Transplantation

Masatsugu Tanaka, Masaharu Tamaki, Naoyuki Uchida, Yuta Katayama, Yuta Hasegawa, Hiroki Hosoi, Kazuki Yoshimura, Kimikazu Yakushijin, Kazuaki Kameda, Fumihiko Ishimaru, Hideki Nakasone, Satoshi Takahashi, Shuichi Ota, Yasuo Mori, Tetsuya Eto, Junya Kanda, Makoto Yoshimitsu, Noriko Doki, Hirohisa Nakamae, Satoshi Yoshihara, Takahiro Fukuda, Yoshiko Atsuta
article en
1 citations

Abstract

Although second allogeneic hematopoietic cell transplantation HCT (HCT2) is a potentially curative treatment for patients relapsing after their first HCT (HCT1), it is associated with higher non-relapse mortality (NRM) compared with HCT1. Furthermore, while reduced-intensity conditioning (RIC) in HCT2 might decrease NRM, there is no consensus on which patients may benefit from RIC. We retrospectively analyzed 2478 patients who underwent HCT2 for relapse of hematologic malignancies after HCT1. In a multivariate analysis, older recipient age, short duration between HCT1 and HCT2, RIC in HCT1, HCT-CI ≥ 2, and ECOG PS ≥ 2 were associated with an increased risk of NRM. RIC in HCT2 was associated with better NRM compared to myeloablative conditioning (MAC) (hazard ratio [HR] 0.83, 95% confidence interval [CI]: 0.72-0.97; p = 0.018), but was not significantly associated with overall survival (OS) (HR 0.91, 95% CI: 0.82-1.01; p = 0.075). We observed a significant interaction for NRM between extensive cGVHD in HCT1 and the conditioning intensity of HCT2 (interaction p < 0.001), meaning that the benefit of RIC in HCT2 was seen in patients with extensive cGVHD in HCT1, but not in those without cGVHD. RIC in HCT2 was also associated with superior OS in patients with extensive cGVHD in HCT1 (HR 0.68, 95% CI: 0.49-0.93; p = 0.02), with significant interaction between the conditioning intensity and the prior history of extensive cGVHD (interaction p = 0.01). This study suggests that RIC in HCT2 reduces NRM for HCT2 and improves OS, especially in patients with a history of extensive cGVHD.

American Journal of HematologyVol. 100(7)
Kagoshima University (JP), Jichi Medical University (JP), Aichi Medical University (JP), Wakayama Medical University (JP), Kyoto University (JP), Japanese Red Cross Society, Japan (JP), Kanagawa Prefectural Hospital Organization (JP), Tokyo Metropolitan Komagome Hospital (JP), Yale University (US), Kobe University Hospital (JP), Kyushu University Hospital (JP), Hamanomachi Hospital (JP), Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital (JP), Sapporo Hokuyu Hospital (JP), Hokkaido University Hospital (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Osaka City University Hospital (JP), Jichi Medical University Saitama Medical Center (JP), Toranomon Hospital (JP), Kanagawa Cancer Center, Osaka Metropolitan University (JP), The University of Tokyo (JP), Hyogo University (JP)
Good health and well-being
Openalex Percentile: Top 16%
Hematopoietic Stem Cell Transplantation
1.77
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