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Survival outcomes and risk factors of second allogeneic hematopoietic cell transplantation in non-remission status for acute myeloid leukemia

Bone Marrow Transplantation volume 60, pages 1275–1277 (2025)Cite this article

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Second allogeneic hematopoietic cell transplantation (HCT2) is a useful option for treating relapsed acute myeloid leukemia (AML) after the first allogeneic hematopoietic cell transplantation (HCT1). Performing HCT2 for relapsed AML in complete remission is frequently difficult because of the overall response rate of 40–50% with salvage chemotherapy for relapsed myeloid malignancies after HCT1 [1, 2]. Previous studies evaluating risk factors in patients undergoing HCT2 for relapsed AML reported 2-year overall survival (OS) rates of 30–40% [3,4,5] but did not uniformly define the disease status as non-remission at the time of HCT2. Therefore, the efficacy of HCT2 in non-remission status for AML remains unclear. Using a Japanese nationwide data registry, we analyzed the outcomes and associated risk factors in patients with AML who underwent HCT2 while in non-remission. Materials and Methods are presented in Supplementary Information.

The study included 605 eligible patients (Supplementary Table 1), with a median age of 46 (range, 16‒70) years. The median follow-up duration for survivors was 4.5 (range, 0.1‒11.6) years. In 587 patients (96.2%), the donors for HCT1 and HCT2 differed. The cohort of patients undergoing HCT2 during 2016‒2020 included significantly more patients with a performance status (PS) 0‒1 and peripheral blood (PB) blasts before conditioning treatment <20% than those undergoing HCT2 during 2011‒2015. The rates of patients with PB blasts ≥20%, an HCT1–relapse interval of <180 days, and an HCT1–HCT2 interval of <365 days were higher among 124 patients undergoing HCT2 using haploidentical donor (Haplo) than other donor sources. Post-transplant cyclophosphamide (PTCY) and anti-thymocyte globulin were used in 33 and 67 haploidentical transplantations, respectively, for acute graft-versus-host disease (aGVHD) prophylaxis.

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Fig. 1: Outcomes of HCT2 for non-remission AML over the years.

Data availability

The data of this study are not publicly available due to ethical restrictions that it exceeds the scope of the recipient/donor’s consent for research use in the registry. Data may be available from the corresponding author upon reasonable request and with permission of the Japanese Society for Transplantation and Cellular Therapy/Japanese Data Center for Hematopoietic Cell Transplantation.

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Acknowledgements

The authors are grateful to the physicians and data managers at the participating centers for their contributions to data collection for the Transplant Registry Unified Management Program of the Japanese Data Center for Hematopoietic Cell Transplantation.

Author information

Authors and Affiliations

  1. Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan

    Masahiro Teramoto & Satoshi Yoshihara

  2. Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan

    Yoshimitsu Shimomura

  3. Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan

    Hiroki Hosoi

  4. Department of Hematology and Oncology, Nagoya City University East Medical Center, Nagoya, Japan

    Masamitsu Yanada

  5. Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan

    Shohei Mizuno

  6. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  7. Hematology, Oncology & Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan

    Yasuo Mori

  8. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  9. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Wataru Takeda & Takahiro Fukuda

  10. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  11. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  12. Department of Hematology, Osaka Metropolitan University Hospital, Osaka, Japan

    Hirohisa Nakamae

  13. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Takuro Kuriyama

  14. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Masako Toyosaki & Makoto Onizuka

  15. Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan

    Kazunori Imada

  16. Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan

    Mamiko Sakata-Yanagimoto

  17. Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  18. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Yoshiko Atsuta

  19. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  20. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

Authors
  1. Masahiro Teramoto
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  2. Yoshimitsu Shimomura
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  4. Masamitsu Yanada
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  5. Shohei Mizuno
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  9. Wataru Takeda
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  20. Takahiro Fukuda
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  21. Yoshiko Atsuta
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  22. Takaaki Konuma
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Contributions

MTeremoto designed the study, performed the statistical analysis, interpreted the data, and drafted the original manuscript. YS, HH, MY, SM, and TKonuma provided critical feedback on the manuscript and participated in data interpretation. NU, YM, ND, WT, YK, SO, HN, TKuriyama, SY, MToyosaki, KI, MSY, MO, JK, TF, and YA contributed to data acquisition. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Masahiro Teramoto.

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Competing interests

SM received research funding from Hayashikane Sangyo and a lecture fee from Janssen Pharmaceutical. The other authors declare no conflicts of interest.

Ethics approval and consent to participate

All methods were performed in accordance with the Declaration of Helsinki and relevant guidelines and regulations. This study was approved by the Institutional Review Board of Hyogo Medical University (approval number: 4698). All participating patients provided written informed consent to the Japanese Society for Transplantation and Cellular Therapy at the time of registration.

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Teramoto, M., Shimomura, Y., Hosoi, H. et al. Survival outcomes and risk factors of second allogeneic hematopoietic cell transplantation in non-remission status for acute myeloid leukemia. Bone Marrow Transplant 60, 1275–1277 (2025). https://doi.org/10.1038/s41409-025-02640-z

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