title: Second allogeneic hematopoietic stem cell transplantation for juvenile myelomonocytic leukemia: case report and literature review.
abstract: Juvenile myelomonocytic leukemia (JMML) is a rare clonal myeloproliferative disease in young childhood. Hematopoietic stem cell transplantation (HSCT) is the only way to cure the disease, but relapse after HSCT remains a major cause of treatment failure. A 5-year-old girl with JMML, who had experienced a relapse after the first transplant, did not respond to donor lymphocyte infusion and withdrawal of immune-suppressing agents. She was successfully treated using a second transplant. Detailed reports from the English literature since 1988 relating to a total of 13 JMML patients undergoing a second transplant were reviewed. Seven of the 13 JMML patients (54%) were alive and disease-free, with a median follow-up of 53 months after the second transplant. Within the first 6 months following the initial transplant, 10 JMML patients suffered either autologous recovery (n = 6) or early relapse (n = 4). Seven of the 10 (70%) were alive, with a median survival period of 53 months after the second transplant. Six JMML patients underwent retransplantation within 6 months of the first transplant, with three of these (50%) alive at follow-ups of 24, 57, and 90 months after the second procedure. The authors conclude that a second transplant within 6 months may be worth considering for JMML patients who experience autologous recovery or earlier relapse after the first transplant.
authors.affiliation: Department of Pediatrics, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chang
authors.forename: Shiann-Tarng
authors.initials: ST
authors.lastname: Jou
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Lu
authors.forename: Kai-Hsin
authors.initials: KH
authors.lastname: Lin
mesh_terms: D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome