title: Second hematopoietic stem cell transplantation in myeloid malignancies.
abstract: 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.
authors.affiliation: Department of Medicine, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Arfons
authors.forename: Marcie
authors.initials: M
authors.lastname: Tomblyn
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents