title: Second allogeneic stem cell transplant for aplastic anaemia: a retrospective study by the Severe Aplastic Anaemia Working Party of the European Society for Blood and Marrow Transplantation.
abstract: We analysed the outcome of a second allogeneic haematopoietic stem cell transplant (alloHSCT) in 162 patients reported to the European Society for Blood and Marrow Transplantation between 1998 and 2009. Donor origin was a sibling in 110 and an unrelated donor in 52 transplants, respectively. The stem cell source was bone marrow in 31% and peripheral blood in 69% of transplants. The same donor as for the first alloHSCT was used in 81% of transplants whereas a change in the choice of stem cell source was reported in 56% of patients, mainly from bone marrow to peripheral blood. Neutrophil and platelet engraftment occurred in 85% and 72% of patients, after a median time of 15 and 17 days, respectively. Grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 21% and 37% of patients, respectively. Graft failure (GF) occurred in 42 patients (26%). After a median follow-up of 3·5 years, the 5-year overall survival (OS) was 60·7%. In multivariate analysis, the only factor significantly associated with a better outcome was a Karnofsky/Lansky score ≥80 (higher OS). We conclude that a second alloHSCT is feasible rescue option for GF in SAA, with a successful outcome in 60% of cases.
authors: Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Simone
authors: S
authors: Cesaro
authors: Hôpital St. Louis Dept.of Haematology - BMT University Paris VII-Paris Diderot, Paris, France.
authors: Regis
authors: R
authors: Peffault de Latour
authors: Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Gloria
authors: G
authors: Tridello
authors: Clinica di Oncoematologia Pediatrica Dipartimento di Pediatria, Padova, Italy.
authors: Marta
authors: M
authors: Pillon
authors: Dept of Haematology, University Hospital, Uppsala, Sweden.
authors: Kristina
authors: K
authors: Carlson
authors: Paediatric Haematology, Regina Margherita Hospital, Torino, Italy.
authors: Franca
authors: F
authors: Fagioli
authors: Hôpital Claude Huriez Service de Maladies du Sang, Lille Cedex, France.
authors: Jean-Pierre
authors: JP
authors: Jouet
authors: St. George's Hospital Department of Haematology, London, UK.
authors: Mickey B C
authors: MB
authors: Koh
authors: Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Irene Sara
authors: IS
authors: Panizzolo
authors: Medical University of Silesia, Univ. Dept. of Haematology and BMT, Katowice, Poland.
authors: Slawomira
authors: S
authors: Kyrcz-Krzemien
authors: Dept. of Haematology, University Hospital Gasthuisberg, Leuven, Belgium.
authors: Johan
authors: J
authors: Maertens
authors: Divisione di Ematologia, Ospedali Riuniti di Bergamo, Bergamo, Italy.
authors: Alessandro
authors: A
authors: Rambaldi
authors: Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany.
authors: Brigitte
authors: B
authors: Strahm
authors: Programme de Transplantation &Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
authors: Didier
authors: D
authors: Blaise
authors: Federal Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russia.
authors: Alexei
authors: A
authors: Maschan
authors: Department of Haematological Medicine, King's College Hospital/King's College London, London, UK.
authors: Judith
authors: J
authors: Marsh
authors: Paediatric Haematology, Institute G. Gaslini, Genova, Italy.
authors: Carlo
authors: C
authors: Dufour
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy*; D001772:Blood Cell Count; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016879:Salvage Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: graft failure; haematopoietic stem cell transplantation; rescue treatment; second allogeneic transplant; severe aplastic anaemia