Second hematopoietic stem cell transplantation in myeloid malignancies.
OBJECTIVE
Hematopoietic stem cell and umbilical cord blood transplantation can be a life-saving procedure for many patients with myeloid malignancies. The posttransplant period, however, can be complicated by graft failure and disease relapse, prompting the need for further therapy. Herein, we review and examine the data of second allogeneic stem cell transplant after autologous, allogeneic and umbilical cord blood transplantation.


RESULTS
Although large, prospective, multicenter trials are lacking, certain factors such as younger patient age, lower disease burden and a longer interval between first transplantation and relapse appear to portend a better prognosis for second transplant.


CONCLUSIONS
Currently, only a selected group of patients without important comorbidities should be considered for second allogeneic transplantation. Strategies such as new immunosuppressive agents, antileukemia monoclonal antibodies, graft modification and use of molecularly targeted therapy are needed to decrease the morbidity and increase the efficacy of transplantation.
Arfons
Lisa M
LM
Department of Medicine, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Tomblyn
Marcie
M
Rocha
Vanderson
V
Lazarus
Hillard M
HM
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D036101:Cord Blood Stem Cell Transplantation; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D014184:Transplantation, Homologous
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents