title: Outcome of second allogenic stem cell transplantation in pediatric patients with non-malignant hematological and immune deficiency disorders.
abstract: BACKGROUND
  Second stem cell transplantation (SCT) is usually associated with high morbidity and mortality and the data on its outcome in pediatric patients with non-malignant disorders are scarce.
  
  
  METHODS
  We present 30 children with non-malignant conditions who underwent second SCT at our institution for graft failure after the first SCT; 20 had a non-malignant hematological disorder and 10 had an immune deficiency disorder. Median age at the second SCT was 6.1 years (range, 0.4-13 years) and median time from the first SCT to the second SCT was 6.2 months (range, 1.2-96 months).
  
  
  RESULTS
  Twenty patients (70%) engrafted; severe acute GVHD developed in four patients (13%), and chronic GVHD developed in two patients of those at risk (10%). Thirteen deaths occurred and nine were considered treatment related. The 5-year overall (OS) and event free survival (EFS) for all patients were 53% and 47% respectively. The interval between the two transplants seemed to affect the outcome; patients who had the second SCT ≥ 6 months from the first SCT had better survival; the 5-year OS for the two groups (<6 months and ≥ 6 months) respectively were 30% and 74% (P = 0.004), and the 5-year EFS were 27% and 66% (P = 0.004). The underlying disease did not affect the outcome nor did the use of radiation in the conditioning regimen for the second SCT.
  
  
  CONCLUSIONS
  Second SCT for graft failure should be considered for children with non-malignant hematological and immune deficiency disorders.
authors.affiliation: Section of Pediatric Stem Cell Transplantation, Department of Pediatric Hematology-Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. mouhab@kfshrc.edu.sa.
authors.forename: Mouhab
authors.initials: M
authors.lastname: Ayas
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Jefri
authors.forename: Abdelmoneim
authors.initials: A
authors.lastname: Eldali
authors.forename: Amal
authors.initials: A
authors.lastname: Al-Seraihi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Mahr
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al-Ghonaium
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Ahmari
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Muhsen
authors.forename: Hamoud
authors.initials: H
authors.lastname: Al-Mousa
authors.forename: Hasan
authors.initials: H
authors.lastname: Al-Dhekri
authors.forename: Bandar
authors.initials: B
authors.lastname: Al-Saud
authors.forename: Hassan
authors.initials: H
authors.lastname: El-Solh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000601:surgery; D006402:Hematologic Diseases / Q000401:mortality / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000401:mortality / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D012086:Reoperation; D014184:Transplantation, Homologous; D017211:Treatment Failure