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Related Experiment Videos

Who should get a second marrow transplant?

K Atkinson1

  • 1Department of Haematology, St Vincent's Hospital, Sydney, Australia.

Bone Marrow Transplantation
|January 1, 1992
PubMed
Summary
This summary is machine-generated.

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Second marrow transplants are considered for graft failure or malignancy recurrence after initial transplantation. Early relapse (<6 months) yields poor outcomes, while later relapse (>6 months) shows improved survival rates post-second transplant.

Area of Science:

  • Hematology
  • Transplant Immunology
  • Oncology

Background:

  • Second marrow transplantation is a critical intervention in specific clinical scenarios.
  • These include primary graft failure and relapse of hematological malignancies post-initial transplant.

Purpose of the Study:

  • To outline clinical indications for second marrow transplants.
  • To discuss therapeutic strategies for graft failure.
  • To analyze outcomes based on relapse timing after initial transplantation.

Main Methods:

  • Review of clinical situations necessitating second transplants.
  • Evaluation of treatment approaches for engraftment failure, including recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) and specific preparative regimens.

Related Experiment Videos

  • Analysis of multi-institutional data correlating relapse timing with leukemia-free survival after second transplants.

    • Main Results:

    • Recombinant human GM-CSF may improve blood counts in some patients with engraftment failure.
    • Preparative regimens involving antithymocyte globulin (ATG) and cyclophosphamide or ATG alone are options for refractory engraftment failure.
    • Leukemia-free survival after second transplant is significantly lower (<10%) for early relapses (<6 months) compared to later relapses (>30% for >6 months).
    • Second transplants carry a higher risk of transplant-related mortality, including interstitial pneumonitis and hepatic veno-occlusive disease.

    Conclusions:

    • Second marrow transplantation is indicated for both graft failure and malignancy recurrence.
    • Treatment for engraftment failure should first involve recombinant human GM-CSF, followed by intensified immunosuppressive preparative regimens if unsuccessful.
    • Timing of relapse is a crucial prognostic factor for long-term survival after second marrow transplantation, with later relapses conferring a better outlook.