title: Second allogeneic bone marrow transplants from unrelated donors for graft failure following initial unrelated donor bone marrow transplantation.
abstract: Graft failure is a common and severe complication of unrelated donor bone marrow transplantation (UD-BMT). However, there are few reports of a second UD-BMT in this setting. We describe 12 patients with graft failure (five primary, seven secondary) who had a second transplant, five from their original donor and seven from a different donor. Their median age was 9 years. Two patients died before day 10 of regimen-related toxicity. Nine of 10 evaluable patients engrafted in a median of 17 days. Secondary graft failure was seen in one patient. Transplant-related morbidity was significant. Six of nine developed acute GHVD, there were five severe infections and five patients developed Bearman grade 3 or 4 extramedullary toxicity. Overall, five patients survive at a median of 38 months after the second BMT and two are in continuous complete remission. Second transplants from unrelated donors for graft failure can result in prolonged survival.
authors.affiliation: Bone Marrow Transplant Unit, Bristol Royal Hospital for Sick Children, UK.
authors.forename: V L
authors.initials: VL
authors.lastname: Grandage
authors.forename: J M
authors.initials: JM
authors.lastname: Cornish
authors.forename: D H
authors.initials: DH
authors.lastname: Pamphilon
authors.forename: M N
authors.initials: MN
authors.lastname: Potter
authors.forename: C G
authors.initials: CG
authors.lastname: Steward
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome