Role of second bone marrow transplants

Fifteen patients with leukaemia and myelodysplasia (n = 10) or non-malignant disease (5) received a second and one a third BMT following recurrence of malignancy (7), rejection (5) or failure of engraftment (4). Of seven patients retransplanted for relapse, 3 of 3 who were conditioned with total body irradiation (TBI) for the first and chemotherapy for the second BMT relapsed whereas 0 of 4 who were conditioned with busulphan (BU) and CY for the first and TBI and melphalan for the second BMT relapsed. Three of these patients survive disease-free for longer than the remission after first BMT. Four patients with non-malignant disease received a second allogeneic BMT following failure of sustained engraftment and three are well and disease free for 24-75 months. Five patients received an autologous rescue because of failure of sustained engraftment. Three had sustained marrow recovery, with two patients surviving (one free of leukaemia and one with thalassaemia major), 41 and 77 months post-BMT. It is concluded that second allogeneic BMT can lead to prolonged disease-free survival and that TBI/melphalan may be a suitable conditioning therapy for second BMT in patients relapsing after BU/CY. Collection of an autologous back-up provides an additional safety measure in patients at increased risk of failure of sustained engraftment.