[The efficacy and safety of second allogeneic hematopoietic stem cell transplantation for post-transplant hematologic...

To investigate the safety and efficacy of second allogeneic hematopoietic stem cell transplantation for the relapsed hematologic malignancies.

The data of 25 relapsed patients received the second allogeneic transplantation as a salvage therapy in Institute of Hematology Peking University between October 1999 and March 2010 were analyzed retrospectively. Twenty-four patients relapsed at 8.8 (1 - 55) months after the first transplantation, except one received the second transplantation as prophylaxis therapy. They received the second transplantation after 3 (0.3 - 20) months' therapy. The median time between the 2 transplants was 10.6 (0.6 - 59.0) months.

Most of the patients were given the conditioning regimen including total body irradiation (TBI, 700 - 779 cGy) or modified busulfan and cyclophosphamide (BUCY, BU 12 mg). All patients survived more than 30 days and achieved sustained white blood cell engraftment. Sinus obstructive syndrome, irradiation dermatitis and acute myocardial infraction were occurred in 3 patients and recoverable. Until January 31 in 2011, with a median observation period of 9.1 (2.0 - 131.1) months, 8 patients had been living with a overall survival (OS) of 30.9%. Twelve patients relapsed at a median 4.4 months and 10 died of it. The other 7 patients died of transplant related complications. The non-relapsed mortality was 35.1%. The disease status at the 2nd transplantation was the only factor which effected the OS (P = 0.009).

The second allogeneic transplantation is a viable option for patients relapsing after the first transplantation. Reduced intensive conditioning regimen ensures the graft engraftment and reduces transplant related toxicity.