ALLOGENEIC BONE-MARROW TRANSPLANTATION IN PATIENTS WHO RELAPSE AFTER AUTOLOGOUS TRANSPLANTATION

Increasing numbers of patients have received autologous stem cell tran splants (ASCT) for hematologic malignancies, Since only a fraction of these patients are cured, physicians are more frequently faced with th e dilemma of how to manage relapse post-transplant. Potential advantag es of allogeneic transplantation (alloBMT) over ASCT include lack of g raft tumor contamination and presence of a graft-versus-tumor effect, For this reason, patients who relapse after ASCT are often considered candidates for allogeneic bone marrow transplantation. However, there is limited knowledge on the outcome of alloBMT in patients who relapse after ASCT, We retrospectively analyzed the outcome of 20 patients wi th malignant lymphoma (n = 14) and AML (n = 6) who underwent alloBMT a fter failing an ASCT, The median age was 30 (17-41) years and the inte rval from ASCT to alloBMT was 10.5 (2-25) months, Seventeen patients d ied between 0.3 to 11 months (median 2.0) after alloBMT, all due to BM T-related toxicities, Three patients remain alive and free of disease at 1.1, 1.2 and 2.5 years after alloBMT. Sixteen of the 18 evaluable p atients (89%) developed grade II-IV acute GVHD, Patients undergoing al loBMT after ASCT have a very high treatment-related mortality and inci dence of grade II-IV acute GVHD, Alternative treatments with salvage c hemotherapy, radiation or investigational approaches should be conside red in patients who relapse after ASCT.