Cyclophosphamide Followed By Busulphan in Place of Standard BuCy Regimen for Patients Undergoing Allogeneic Stem Cell Transplantation: A Preliminary Experience from a Single Centre in India

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5856-5856
Author(s):  
Sainath Bhethanabhotla ◽  
Ranjit Kumar Sahoo ◽  
Lalit Kumar ◽  
Atul Sharma ◽  
Sameer Bakhshi
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conditioning Regimen ◽  
P Value ◽  
Cell Transplant ◽  
Toxicity Profile ◽  
Hematopoietic Stem ◽  
Significant Difference ◽  
Baseline Characteristics

Abstract Conditioning regimens are an important issue determining the outcome of hematopoietic stem cell transplantation (HSCT). Altering the administration order of Busulphan (Bu) and Cyclophosphamide (Cy) during conditioning from conventional method of administering Bu followed by Cy had resulted in an improved toxicity profile in few animal and subsequent human studies. However the data substantiating this approach is limited. We retrospectively analyzed all consecutive patients receiving allogeneic stem cell transplant (Allo SCT) with myeloablative conditioning from 2009 to 2013. A total of 40 patient received Allo SCT of which 18 patient received Bu-Cy and 22 patients received Cy-Bu conditioning regimen. The Bu–Cy conditioning regimen consisted of i.v. Bu 0.8 mg/kg administered every 6 h (16 doses) on days −7 to −4, followed by i.v. Cy 60 mg/kg on days −3 and −2. Patients with the Cy–Bu regimen received i.v. Cy 60 mg/kg on days −7 and −6; followed by i.v. Bu 0.8 mg/kg administered every 6 hr (16 doses) on days −5 to −2. GVHD prophylaxis was given with Cyclosporine A and methotrexate. Common Terminology Criteria for Adverse Events version 3.0 (CTCAE) was used for assessment of toxicity. The diagnosis of sinusoidal obstruction syndrome (SOS) was based on modified Seattle criteria. Pre-transplant characteristics were comparable in the two cohorts (Table 1a and 1b). Time to platelet engraftment was earlier in the Cy-Bu cohort (21 days vs. 16 days; P=0.008) (Table 2).Treatment related side effects were similar in both the groups except hepatotoxicity which was higher in Bu-Cy as compared to Cy-Bu group (10 (55.16%) vs. 3 (13.64%); p=0.03). There was no significant difference in treatment related mortality (TRM) at day 100; however there was trend towards higher TRM at day 30 in Bu-Cy group (3 vs. none; p=0.083).There was no difference in aGVHD incidence, grade or stage of organ involved between the 2 groups. As in previous studies hepatotoxicity in the present analysis was found to be less in patients who received Cy-Bu as the conditioning regimen and there was earlier platelet engraftment in this group. These findings suggest Cy-Bu has better toxicity profile than conventional Bu-Cy regimen. However further prospective studies are required to confirm these findings. Table 1a. Baseline Characteristics Patient Characteristics Bu-Cy (n=18) Cy-Bu (n=22) P value Sex Male 15 16 0.424 Age (in yrs) Median (Range) 17 (1-50) 16 (1-48) ≤18 9 13 ≥18 9 9 Underlying Disease AML 14 12 0.415 ALL 3 4 CML 1 3 MDS 0 2 Primary Myelofibrosis 0 1 Pre-transplant Remission Status CR 11 11 0.482 Performance status (ECOG) 0 4 3 0.314 1 9 16 HSCT Comorbidity Index 0 14 15 0.341 1 1 5 2 2 2 3 1 0 Table1b. Baseline Characteristics Transplant characteristics Bu-Cy Cy-Bu P value Time from diagnosis to Transplant Mean (days) + SD 548.1 675 0.567 HLA Matching HLA identical (6/6) 17 21 0.884 HLA mismatch (5/6) 1 1 Donor Matched Sibling 17 16 0.884 UCB 1 1 Donor Age Median(Range) 20 (0-47) 16 (0-50) 0.781 Donor Sex Male 5 14 0.034 Female 12 8 Sex mismatch 12 13 0.458 Female Donor in Male patient 11 7 0.064 Harvest Source Peripheral Blood (PB) 15 21 0.269 Bone Marrow (BM) 2 0 Cord Blood (UCB) 1 1 CD 34 Count(x106 cells/kg) Mean+SD 5.12+2.60 5.66+2.37 0.499 CD 3 Count(x107 cells/kg) Mean 25.5 17.5 0.200 Table 2 Results Outcome Bu-Cy Cy-Bu P ANC recovery 14 (11-30) 11 (8-32) 0.119 Platelet recovery 21 (17-44) 16 (11-27) 0.008 Platelets transfused 6 (1-10) 4 (1-15) 0.166 Days of GCSF 18 (12-36) 14 (9-37) 0.126 D100 Complete Donor Chimerism 9 (90%) 12(85.71%) 1.000 Transplant Response 15/17 (88.24%) 19/22 (86.36%) 1.000 Days of Antimicrobial use 13 (0-34) 13 (0-36) 0.83 Hepatotoxicity (grade3-4) 10/18 (55.56%) 3/22 (13.64%) 0.030 Nephrotoxicity (grade3-4) 3/18 (16.67%) 1/22 (4.55%) 0.204 Mucositis (grade3-4) 6/18 (33.33%) 6/22 (27.27%) 0.677 Any Grade 3-4 toxicity 10/18 (55.56%) 9/22 (40.91%) 0.356 D30 TRM 3 (16.67%) 0 0.083 D100 TRM 4 (22.22%) 2 (10%) 0.395 Follow up 28.67 months 7.6 months Acute GVHD 3/18 (16.67%) 5/22 (22.73%) 0.709 Disclosures No relevant conflicts of interest to declare.

scholarly journals Greffe allogénique de cellules souches hématopoïétiques

2017 ◽  
pp. 90-97
Author(s):  
Assia Alem ◽  
◽  
Farah Bouamama ◽  
Mohamed Brahimi ◽  
Mohamed Amine Bekadja
Keyword(s):  
Stem Cell ◽  
Immune System ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Ex Vivo ◽  
Transplant Rejection ◽  
Conditioning Regimen ◽  
Hla Typing ◽  
Cell Transplant ◽  
Hematopoietic Stem

Allogeneic hematopoietic stem cell transplantation is a potentially curative procedure for a variety of malignant and non-malignant diseases of the bone marrow or the immune system. It consists of administration to the recipient a conditioning regimen including various combinations of chemotherapy, radiotherapy and immunotherapeutic agents which aims to destroy its immune system (to prevent transplant rejection) and, to a varying degree, malignant clone. Conditioning is followed by injection of the graft of hematopoietic stem cells. In this graft, the cells can recognize and destroy residual tumor cells of the recipient (graft effect against leukemia HVL). This reaction explains the interest of the allogeneic stem cell transplantation in hematological malignancies. Meanwhile, the immune system of the graft may cause deleterious reactions against recipient’s organs that is the GVHD (graft against the host disease). HCT is associated with morbidity and mortality related to the toxicity of conditioning, GVHD and post-transplant immunosuppression. The incidence and severity of these complications depends on both parameters specific to the recipient (age, status of the blood disease) and the terms of the graft (type of packaging, HLA compatibility between the donor and the receiver, ex vivo manipulation of the graft, graft type). The development of new techniques and transplant procedures has improved the survival of transplanted patients and expand transplant indications. The main progress concerns the development of reduced conditioning, peripheral stem cell transplant or cord blood, and improved HLA typing techniques in unrelated transplants.

scholarly journals Multicenter Outcome of Hematopoietic Stem Cell Transplantation for Primary Immune Deficiency Disorders in India

2021 ◽  
Vol 11 ◽  
Author(s):  
Revathi Raj ◽  
Fouzia N. Aboobacker ◽  
Satya Prakash Yadav ◽  
Ramya Uppuluri ◽  
Sunil Bhat ◽  
...  
Keyword(s):  
Immune Deficiency ◽  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conditioning Regimen ◽  
P Value ◽  
Primary Immune Deficiency ◽  
Hematopoietic Stem

BackgroundHematopoietic stem cell transplantation (HSCT) is the curative option for many primary immune deficiency disorders (PID). In the last 5 years, increased awareness, availability of diagnostics based on flow cytometry, genetic testing, improved supportive care, use of reduced toxicity conditioning, and success of haploidentical donor HSCT have improved access to HSCT for children with PID in India. We present results on children with PID who underwent HSCT across India and the factors that influenced outcome.Patients and MethodsWe collected retrospective data on the outcome of HSCT for PID from seven centers. We analyzed the impact of the type of PID, conditioning regimen, time period of HSCT- before or after January 2016, graft versus host disease prophylaxis, cause of mortality and overall survival.ResultsA total of 228 children underwent HSCT for PID at a median age of 12 months (range, 1 to 220 months) with a median follow up of 14.4 months. Infants accounted for 51.3% of the cohort and the male female ratio was 3:1. SCID (25%) and HLH (25%) were the more frequent diagnoses. Matched family donor was available in 36.4% and 44.3% children had a haploidentical HSCT. Reduced and myeloablative conditioning regimens were used with 64% children receiving a treosulfan based conditioning regimen. Peripheral blood stem cells were the predominant graft source at 69.3%. The survival in infants (60.2%) was inferior to children aged over 1 year (75.7% p value = 0.01). Children with Wiskott Aldrich syndrome (74.3%) and chronic granulomatous disease (82.6%) had the best outcomes. The survival was superior in children receiving HSCT from a matched sibling (78%) versus an alternate donor HSCT (61% p value = 0.04). In the cohort transplanted after January 2016 survival improved from 26.8% to 77.5% (p value = 0.00). Infection remains the main cause of mortality at in over 50% children. The 5-year overall survival rate was 68%.ConclusionSurvival of children with PID undergoing HSCT in India has improved dramatically in last 5 years. Alternate donor HSCT is now feasible and has made a therapeutic option accessible to all children with PID.

scholarly journals Contemporary Conditioning Regimen before Allogeneic Stem Cell Transplantation for Children with Non-Malignant Diseases

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3398-3398
Author(s):  
Christina Peters ◽  
Mary Slatter ◽  
Paul Veys ◽  
Franco Locatelli ◽  
Adriana Balduzzi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Research Funding ◽  
Bone Marrow Failure ◽  
Conditioning Regimen ◽  
Common Disease ◽  
Malignant Diseases ◽  
Hematopoietic Stem ◽  
Significant Difference

Abstract Non-malignant diseases (NMD) include a wide spectrum of either congenital or acquired disorders occurring in early and later childhood. The primary goal of conditioning in NMD is either the replacement of missing cells as in severe aplastic anaemia (SAA) or severe combined immunodeficiencies (SCID) or the exchange of a deficient blood cell compartment as in hemoglobinopathies, hemophagocytic syndromes or metabolic disorders. The right choice of a conditioning regimen before allogeneic hematopoietic stem cell transplantation (HSCT) is crucial for the outcome of patients with NMD, many of whom are often critically ill due to infections, organ dysfunctions, vascular complications or metabolic problems. As a consequence of a highly activated immune-system and no pre-treatment with chemotherapy, graft rejection is a known severe complication in these patients. To get up-to-date information on the most commonly used conditioning regimen for children with NMD, we performed an EBMT- registry-based analysis: 2187 patients from 39 countries with a congenital or acquired NMD below the age of 18 years who underwent first allogeneic HSCT between January 2010 and December 2014 registered in the EBMT database were included. 51% of children were transplanted before 4 years of age, 489 patients were less than 12 months old, and 61.5% were male. Majority of patients (32,2%) underwent HSCT for hemoglobinopathies (463 thalassemia major, 127 sickle cell disease), the second most common disease type was SCID with 17.4%, followed by other primary immunodeficiencies, chronic granulomatous disease and bone marrow failure syndromes (excluding Fanconi anaemia): 13.2%, 11% and 10.4%, respectively. The given conditioning regimen was under discretion of the treating physician. The most common conditioning regimen consisted of a combination of busulfan (bu)/fludarabine (flu) in 1063 patients, of treosulfan (treo)/flu in 422 patients; 473 patients received a combination of treo/flu/thiotepa (tt) and 229 patients received bu/flu/tt. The median total dose of the respective conditioning drugs was comparable (treo: 41 g/m2 or 42g/m2; bu: 160 mg/m2; tt: 201 and 205 mg/m2). In univariate analysis, overall survival (OS) was significantly different between the conditioning groups (p = 0.0032): 2y-OS 87.7% [84.3%-91.2%] for treo/flu/tt vs. 82.4% [78.5%-86.5%], 81.8% [77.8%-86.0%] for treo/flu, 80.8% [78.1%-83.5%] and 78.2% [75.2%-81.3%] for bu/flu and 81.3% [75.9%-87.0%] and 80.4% [74.9%-86.4%] for bu/flu/tt, respectively. Transplant-related mortality (TRM) was significantly different between the conditioning groups (p = 0.0015): day-100 TRM was lowest after treo/flu/tt: 4.8% [2.8%-6.7%] compared to 9.2% [6.3%-12.0%] after treo/flu, 7.9% [6.2%-9.5%] after bu/flu and 9.9% [5.9%-13.8%] after bu/flu/tt. TRM at 1 year post-transplant: 8.3% [5.5%-11.0%] for treo/flu/tt, 16.2% [12.2%-20.0%] after treo/flu, 16.9% [14.2%-19.4%] after bu/flu and 14.9% [9.7%-19.8%] after blu/flu/tt, respectively. In multivariate analysis, the HR was adjusted on age groups at HSCT, underlying disease, year of HSCT, stem cell source and donor types. 1-y OS was significantly better after treo/flu/tt (89.5 [86.5 - 92.6], CI 95%, p 0.0032) than with treo/flu, bu/flu or bu/flu, respectively. Day 100- and 1-year TRM was lower after treo/flu/tt compared to the other three conditioning combinations. A pairwise testing of the different treatment groups revealed no statistical significant difference in OS, TRM, disease-free survival (DFS) for bu/flu vs. treo/flu, bu/flu vs. bu/flu/tt and bu/flu/tt vs. treo/flu; a significant better OS, DFS and less TRM for treo/flu/tt vs. bu/flu, treo/flu/tt vs. treo/flu and a better DFS for treo/flu/tt vs. bu/flu/tt with a trend for better OS and less TRM for treo/flu/tt vs. bu/flu/tt. No statistically significant differences were found among the 4 conditioning regimens for acute or chronic GVHD. Conclusion: For children with NMD, a variety of conditioning regimen are in use to facilitate engraftment, prevent rejection, and enable sufficient cell function. Beside treo and bu, flu and tt are established drugs to eradicate lymphocytes. In this analysis, the combination of treo/flu/tt shows promising outcome results and should be further evaluated in diseases specific prospective trials. Disclosures Peters: Pfizer: Consultancy; Amgen: Consultancy; Jazz: Speakers Bureau; Novartis: Consultancy; Medac: Consultancy. Slatter:Medac: Other: Travel grants. Bader:Medac: Consultancy, Research Funding; Riemser: Research Funding; Neovii Biotech: Research Funding; Servier: Consultancy, Honoraria; Novartis: Consultancy, Honoraria.

Hematopoietic Stem Cell Transplantation for Hemophagocytic Lymphohistiocitosis : A National Retrospective Analysis of Data from the Italian Association of Pediatric Hematology Oncology (AIEOP)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 621-621
Author(s):  
Chiara Messina ◽  
Marco Zecca ◽  
Franca Fagioli ◽  
Attilio Rovelli ◽  
Edoardo Lanino ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Pediatric Hematology ◽  
Significant Difference

Abstract Hemophagocytic lymphohistiocytosis (HLH) is a hyper inflammatory syndrome generally observed in children or in adolescent. The familial form (FHL) is indeed a congenital immune deficiency. To date, four subtype are defined by mutations in different genes: PRF1 in FHL 2, UNC13D in FHL3, STX11 in FHL4, STXBP2 in FHL5. Moreover, some patients with other congenital immune deficiencies (X-linked lymphoproliferative disorders, Griscelli syndrome, Chédiak-Higashi syndrome, and hermansky -Pudlak syndrome) may develop HLH. An overlapping clinical picture, secondary or HLH, may be observed following viral, fungal infections, Leishmaniosis in patients with no evidence of genetic defect (1). The approach to patients with FHL/HLH is aimed to achive a clinical remission. The treatment includes immunosuppressive and cytotoxic therapy followed by hematopoietic stem cell transplantation (HSCT) in children familial, persistent or recurrent disease (2). Nevertheless, increased complications and morbidity in children with FHL/HLH were described. We retrospectively analyzed 121 patients with FHL/HLH who underwent HSCT from January 1990 to December 2014 at nine Centers affiliated to AIEOP. 61 of these patients were already reported (3). 74 were male, 47 female; they were diagnosed at a median age of 1 year (range 0.4-18 years). The majority of patients were treated according to International HLH-94 Protocol. Ninety- two children (76%) had a complete genetic study which lead to the diagnosis of FHL2 (31 patients), FHL3 (30 patients), FHL5 (2 patients), Griscelli (6 patients), X-linked lymphoprolypherative disease 1 (5 patients), X-linked lymphoprolypherative disease 2 (2 patients), CATCH22 syndrome (1 patient). No mutations were found in 15 children whereas 28 patients were not studied. The majority of children (70%) had active disease or partial remission at the time of HSCT. The donor for the first HSCT was either a relative (24%) or an unrelated volunteer (64%). According to stem cell source, 76% of children received BM, 18% CB and 6% PBSC. Forty-eight patients underwent a myeloablative conditioning regimen based on cyclophosphamide plus TBI (4 patients ) or plus busulfan (BU) (44 patients). The remaining patients received a reduced intensive conditioning regimen including fludarabine combined with BU and thiotepa (TT) (28 patients), or with TT and treosulfan (16 patients), or with melphalan ± TT (29 patients). The overall rejection incidence was 5% (CI 1%-10%) while the overall relapse incidence of primary disease was 10% (CI 6%-18%). The Bearman grading III-IV regimen-related toxicity was 30 % leading to an overall 5-year TRM of 28% (CI 21%-38%). No significant difference was observed according to year of transplant in the TRM. Overall, 37 patients died: 4 for progression of primary disease, 11 for infections (fungal 6, bacterial 3, viral 2), 5 for hepatic and 2 for lung VOD, 7 for MOF, 5 for hemorrhage, 3 for acute or chronic GVHD. The 5-year EFS and OS were 59% (CI 50%-68%) and 68% (CI 59%-77%), respectively. No significant difference was recorded in terms of EFS by year of HSCT. The 5-year DFS was not significantly correlated to donor type, or to stem cell source, or to age at diagnosis. Patients transplanted in first CR had a better 5-year DFS compared to patients transplanted in other CR (72% versus 29%, p= 0,001), whereas no significant difference was noted when patients were transplanted with active disease (72% versus 58%).To our knowledge, this is the largest series of children and adolescent affected by FLH/HLH who underwent HSCT. The overall survival rate of 68% confirms that HSCT represents a curative treatment for FLH/HLH, in range with the published data. TRM remains the major barrier to a successful HSCT outcome. 1. Sieni E, Cetica V, Hackmann Y, et al. Familial hemophagocytic lymphohistiocytosis: when rare diseases shed light on immune system functioning. Front Immunol 2014;5:167. 2. Trottestam H, Horne A, Aricò M, et al. Chemoimmunotherapy for hemophagocytic lymphohistiocytosis: long-term results of the HLH-94 treatment protocol. Blood. 2011;118:4577-84. 3. Cesaro S, Locatelli F, Lanino E, et al. Hematopoietic stem cell transplantation for hemophagocytic lymphohistiocytosis: a retrospective analysis of data from the Italian Association of Pediatric Hematology Oncology (AIEOP). Haematologica. 2008;93:1694-701. Disclosures No relevant conflicts of interest to declare.

scholarly journals Tandem Autologous Hematopoietic Stem Cell Transplantation in Very Young Patients with Multiple Myeloma

2020 ◽  
Vol 09 (04) ◽  
pp. 233-235
Author(s):  
Rahul Naithani ◽  
Nitin Dayal ◽  
Reeta Rai
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Young Patients ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Platelet Recovery

Abstract Introduction Multiple myeloma (MM) in very young patients is uncommon, and no treatment guidelines exist for these patients. Patients and Methods We performed a retrospective analysis of five very young myeloma patients who underwent tandem autologous hematopoietic stem cell transplantation (HSCT). Results The median age was 37 years (range = 34–40 years). A median of two leukapheresis was performed (range = 1–4). The median number of hematopoietic stem cells collected was 5.4 × 106/kg (4.4–8.2 × 106/kg). During first transplant, four patients received melphalan of 200 mg/m2 and one patient received melphalan of 140 mg/m2 (due to renal failure) as conditioning regimen. Second transplant conditioning was melphalan of 200 mg/m2 for one patient and melphalan of 140 mg/m2 for remaining four patients. Two patients were in complete remission, and two were in very good partial remission and one patient progressed to active disease at the time of tandem autologous bone marrow transplant. All patients developed significant mucositis. Neutrophil and platelet recovery was longer in tandem autologous hematopoietic stem cell transplant. More viral infections were seen in tandem transplant. Day 30 and day 100 mortality was nil. Conclusion We present data on tandem autologous HSCTs in very young patients with MM in India. Responses continued to improve in this small series.

scholarly journals A review on recipients of hematopoietic stem cell transplantation patients with COVID-19 infection

2021 ◽  
Vol 8 ◽  
pp. 204993612110132
Author(s):  
Kamal Kant Sahu ◽  
Ahmad Daniyal Siddiqui
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Real World Data ◽  
Hematopoietic Stem ◽  
Geographical Regions

For the last few months, various geographical regions and health sectors have been facing challenges posed by the current COVID-19 pandemic. COVID-19 has led to significant disruption in the normal functioning of potentially life-saving therapies of hematopoietic cell transplant and chimeric antigen receptor therapy. As transplant physicians are gaining more information and experience regarding the undertaking of these complex procedures during the ongoing COVID-19 pandemic, we believe it is important to discuss the challenges faced, prognostic risk factors, and outcomes of COVID-19 in post-hematopoietic stem cell transplantation patients based on the available real-world data.

scholarly journals Long-term outcome after allogeneic stem cell transplantation in multiple myeloma

2021 ◽  
Author(s):  
Sini Luoma ◽  
Raija Silvennoinen ◽  
Auvo Rauhala ◽  
Riitta Niittyvuopio ◽  
Eeva Martelin ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Relapse Group

AbstractThe role of allogeneic hematopoietic stem cell transplantation (allo-SCT) in multiple myeloma is controversial. We analyzed the results of 205 patients transplanted in one center during 2000–2017. Transplantation was performed on 75 patients without a previous autologous SCT (upfront-allo), on 74 as tandem transplant (auto-allo), and on 56 patients after relapse. Median overall survival (OS) was 9.9 years for upfront-allo, 11.2 years for auto-allo, and 3.9 years for the relapse group (p = 0.015). Progression-free survival (PFS) was 2.4, 2.4, and 0.9 years, respectively (p < 0.001). Non-relapse mortality at 5 years was 8% overall, with no significant difference between the groups. Post-relapse survival was 4.1 years for upfront-allo and auto-allo, and 2.6 years for the relapse group (p = 0.066). Survival of high-risk patients was reduced. In multivariate analysis, the auto-allo group had improved OS and chronic graft-versus-host disease was advantageous in terms of PFS, OS, and relapse incidence. Late relapses occurred in all groups. Allo-SCT resulted in long-term survival in a small subgroup of patients. Our results indicate that auto-allo-SCT is feasible and could be considered for younger patients in the upfront setting.

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