Second allogeneic stem cell transplantation for acute leukemia using a chemotherapy- Only cytoreduction with clofarabine, melphalan, and thiotepa Journal Article


Authors: Spitzer, B.; Perales, M. A.; Kernan, N. A.; Prockop, S. E.; Zabor, E. C.; Webb, N.; Castro-Malaspina, H.; Papadopoulos, E. B.; Young, J. W.; Scaradavou, A.; Kobos, R.; Giralt, S. A.; O'Reilly, R. J.; Boulad, F.
Article Title: Second allogeneic stem cell transplantation for acute leukemia using a chemotherapy- Only cytoreduction with clofarabine, melphalan, and thiotepa
Abstract: Relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT) remains one of the leading causes of mortality in patients with leukemia. Treatment options in this population remain limited, with concern for both increased toxicity and further relapse. We treated 18 patients with acute leukemia for marrow ± extramedullary relapse after a previous alloHSCT with a myeloablative cytoreductive regimen including clofarabine, melphalan, and thiotepa followed by a second or third transplantation from the same or a different donor. All patients were in remission at the time of the second or third transplantation. All evaluable patients engrafted. The most common toxicity was reversible transaminitis associated with clofarabine. Two patients died from transplantation-related causes. Seven patients relapsed after their second or third transplanation and died of disease. Nine of 18 patients are alive and disease free, with a 3-year 49% probability of overall survival (OS). Patients whose remission duration after initial alloHSCT was >6 months achieved superior outcomes (3-year OS, 74%, 95% confidence interval, 53% to 100%), compared with those relapsing within 6 months (0%) (P <.001). This new cytoreductive regimen has yielded promising results with acceptable toxicity for second or third transplantations in patients with high-risk acute leukemia who relapsed after a prior transplantation, using various graft and donor options. This approach merits further evaluation in collaborative group studies. © 2016 American Society for Blood and Marrow Transplantation
Keywords: leukemia; transplantation; clofarabine; second
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 22
Issue: 8
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2016-08-01
Start Page: 1449
End Page: 1454
Language: English
DOI: 10.1016/j.bbmt.2016.05.001
PROVIDER: scopus
PMCID: PMC4989237
PUBMED: 27184623
DOI/URL:
Notes: Article -- Export Date: 1 September 2016 -- Source: Scopus
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MSK Authors
  1. Nancy Kernan
    437 Kernan
  2. Farid Boulad
    283 Boulad
  3. Susan E Prockop
    195 Prockop
  4. Sergio Andres Giralt
    621 Giralt
  5. Emily Craig Zabor
    162 Zabor
  6. Miguel-Angel Perales
    466 Perales
  7. James W Young
    279 Young
  8. Richard O'Reilly
    585 O'Reilly
  9. Rachel Kobos
    68 Kobos
  10. Barbara Spitzer
    35 Spitzer
  11. Nicholas Michael Webb
    3 Webb