Outcomes of Second Allogeneic Hematopoietic Cell Transplantation for Patients With Acute Myeloid Leukemia

Fevzi F. Yalniz, Rima M. Saliba, Uri Greenbaum, Jeremy Ramdial, Uday Popat, Betul Oran, Amin Alousi, Amanda Olson, Gheath Alatrash, David Marin, Katayoun Rezvani, Chitra Hosing, Jin Im, Rohtesh Mehta, Muzaffar Qazilbash, Jacinth Joy Joseph, Gabriela Rondon, Rashmi Kanagal-Shamanna, Elizabeth Shpall, Richard ChamplinPartow Kebriaei

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Relapse after allogeneic hematopoietic cell transplantation (HCT) leads to poor survival in patients with acute myeloid leukemia (AML). A second HCT (HCT2) may achieve durable remission. To determine the outcomes of patients who received an HCT2 for relapsed AML and to evaluate the predictors of overall survival (OS) and progression-free survival (PFS). We retrospectively reviewed medical records of adult patients who underwent an HCT2 for relapsed AML at our institution during 2000 to 2019. Ninety-one patients were identified with a median age of 44 years (range 18-73) at HCT2. Donor types were HLA-identical sibling (n = 37 [41%]), HLA-matched–unrelated (n = 34 [37%]), haploidentical (n = 19 [21%]), and cord blood (n=1 [1%]). Donors were different at HCT2 in 53% of patients. The majority of patients received reduced intensity conditioning (n = 71 [78%]) and were in remission (n = 56 [61%]) at HCT2. The median remission duration after HCT1 was 8.4 months (range 1-70) and the median time between transplants was 14 months (range 3-73). The median follow-up of surviving patients after HCT2 was 66 months (range 2-171), with 32% alive at time of analysis. The most common cause of death was disease recurrence (n = 45 [73%]). At 2 years, the rates of OS, PFS, progression, and nonrelapse mortality were 36%, 27%, 42%, and 18%, respectively. The development of chronic graft-versus-host disease (GVHD) after first HCT and HCT comorbidity index (HCT-CI) ≥2 at HCT2 were associated with inferior PFS and OS after HCT2. A second HCT is feasible in selected patients with AML who have relapsed after HCT1. Long-term survival benefit is possible in patients without chronic GVHD after HCT1 and HCT-CI <2 at HCT2.

Original languageEnglish
Pages (from-to)689-695
Number of pages7
JournalTransplantation and Cellular Therapy
Issue number8
StatePublished - 1 Aug 2021
Externally publishedYes


  • Acute myeloid leukemia
  • Second allogeneic stem cell transplantation
  • Survival

ASJC Scopus subject areas

  • Hematology
  • Transplantation
  • Immunology and Allergy
  • Cell Biology
  • Molecular Medicine
  • Medicine (all)


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