title: Second early allogeneic stem cell transplantations for graft failure in acute leukaemia, chronic myeloid leukaemia and aplastic anaemia. French Society of Bone Marrow Transplantation.
abstract: In this retrospective multicentre study, we analysed the results of 82 consecutive second early allogeneic transplants for primary (n = 28) or secondary ([n = 54) graft failures performed between 1985 and 1997 in patients with acute leukaemia (n = 33), aplastic anaemia (n = 29) or chronic myeloid leukaemia (n = 20). HLA-matched siblings were used in 64 cases. The same donors were used for both transplants in 56 cases and the first transplant was T-cell depleted in 30 cases. The median age at transplant was 25 years and the median intertransplant time interval was 2 months. Estimates of the 3-year overall survival and day 100 transplant-related mortality were 30% and 53% respectively. A recipient age < 34 years at transplant, an intertransplant time interval > or = 80 d and a positive recipient cytomegalovirus serology were predictors of a better outcome. The use of cyclosporin A (CsA) after second transplant had a dramatic impact on outcome, the best results being observed with CsA alone. The day 40 probability of neutrophil recovery was 73%. The use of peripheral blood progenitor cells (PBPCs) was associated with a higher and faster neutrophil recovery. Other factors associated with neutrophil recovery were an intertransplant time interval > or = 80 d and a positive recipient cytomegalovirus serology. Therefore, second early allogeneic transplantation for graft failure is an effective treatment, especially if patients can receive CsA for graft-versus-host disease prevention and are retransplanted more than 80 d from first transplant.
authors.affiliation: Bone Marrow Transplant Unit, Hôpital Saint-Louis, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Guardiola
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: F
authors.initials: F
authors.lastname: Garban
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.forename: J
authors.initials: J
authors.lastname: Reiffers
authors.forename: M
authors.initials: M
authors.lastname: Attal
authors.forename: A
authors.initials: A
authors.lastname: Buzyn
authors.forename: B
authors.initials: B
authors.lastname: Lioure
authors.forename: P
authors.initials: P
authors.lastname: Bordigoni
authors.forename: N
authors.initials: N
authors.lastname: Fegueux
authors.forename: M L
authors.initials: ML
authors.lastname: Tanguy
authors.forename: J P
authors.initials: JP
authors.lastname: Vernant
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: G
authors.initials: G
authors.lastname: Socié
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000601:surgery; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery*; D006086:Graft vs Host Disease / Q000175:diagnosis; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007938:Leukemia / Q000601:surgery*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine