Second allogeneic stem cell transplantation in hematologic malignancies: a single-center experience

Area of Science:

• Hematology
• Oncology
• Transplantation Medicine

Background:

• Relapse after initial hematopoietic stem cell transplantation (HSCT) in pediatric hematologic malignancies often leads to poor prognoses.
• Second allogeneic HSCT (allo-HSCT) is an option for these patients, but data, especially in children, is limited.

Purpose of the Study:

• To evaluate patient outcomes after a second allo-HSCT in children with relapsed acute leukemia.
• To identify prognostic factors influencing survival in this patient population.

Main Methods:

• Retrospective analysis of 27 pediatric patients with acute leukemia who underwent at least two allo-HSCTs.
• Data collected from May 1997 to September 2010 at Samsung Medical Center.
• Median follow-up of 33 months.

Main Results:

• Eleven out of 27 patients (40.7%) achieved stable remission.
• The 5-year overall survival rate was 32.6%.
• Pre-transplant remission status was the sole significant prognostic factor for survival (44.1% vs. 11.1%, P=0.009).
• No significant differences in survival based on sex, stem cell source, donor type, or graft-versus-host disease.

Conclusions:

• Second allo-HSCT can provide a chance for stable remission in pediatric patients with relapsed acute leukemia.
• Maintaining remission prior to the second allo-HSCT is crucial for improving survival.
• Relapse and treatment-related mortality remain significant challenges.