title: A retrospective review of the outcome after second or subsequent allogeneic transplantation.
abstract: The failure of allogeneic stem cell transplant (allo-SCT) is cumbersome. We analyzed our experience in a second allo-SCT. Between the years 1981 and 2007, 144 patients underwent 2 or more allo-SCT. The first to second transplant interval ranged from 18 days to 13.25 years (median 98 days). The most frequent indications for the second SCT were activity of the basic disease (78), rejection (37), and engraftment failure (25). Twenty-nine of the 144 (20%) patients transplanted survived more then a year with treatment-related mortality of 45.5% as the leading cause of death. Interestingly, despite the low rate of graft-versus-host disease (GVHD) prophylaxis used, only 51 and 16 of the patients developed acute and chronic GVHD (aGVHD, cGVHD), respectively. Factors indicating higher likelihood for survival were nonmalignant disease, a nonrelapse indication for the second SCT, full HLA-matching, and the use of reduced-intensity conditioning (RIC). Age at transplantation, time interval between transplants, the development of GVHD, conditioning regimen, GVHD prophylaxis, or graft source were not shown to influence the prognosis. With a median follow-up of 4.5 years, 25 patients (17.2%) are alive, and 18 are disease-free. We conclude that although toxic, a second allo-SCT can lead to long-term survival.
authors.affiliation: Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah, Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Meirav
authors.initials: M
authors.lastname: Kedmi
authors.forename: Igor B
authors.initials: IB
authors.lastname: Resnick
authors.forename: Liliane
authors.initials: L
authors.lastname: Dray
authors.forename: Memet
authors.initials: M
authors.lastname: Aker
authors.forename: Simcha
authors.initials: S
authors.lastname: Samuel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gesundheit
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Reuven
authors.initials: R
authors.lastname: Or
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Shapira
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous