2ND ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR POSTTRANSPLANT LEUKEMIA RELAPSE - RESULTS OF A SURVEY OF 66 CASES IN 24 JAPANESE INSTITUTES

To assess the consequence of second BMT (BMT2) for leukemia relapse af ter allogeneic BMT, we analyzed the clinical course of 66 recipients w ho were treated by BMT2 in Japan, Diagnoses included 29 ANLL, 27 ALL, six CML and four MDS. Durations between the first BMT (BMT1) to relaps e and BMT1 to BMT2 were 13.5 +/- 13.7 months and 17.4 +/- 13.9 months, respectively, Donors for BMT2 were replaced in 11 cases, Thirty-one p atients were in CR (or CP) at BMT2, Earlier deaths were observed in th ose who received BMT2 within 12 months after BMT1, mostly caused by re gimen-related toxicity and infections, Overall leukemia-free survival rate was 28% at 2 years and 16% at 4 years, Factors influencing the po or prognosis after BMT2 were early (<6 months) relapse, early (<12 mon ths) BMT2, not in remission at BMT2, and ALL. Intensified conditioning did not affect either remission duration or LFS, Among the 39 cases o bserved for more than 100 days, 18 developed chronic GVHD (cGVHD) and showed longer remission duration than those without cGVHD, Our analysi s indicates that BMT2 as treatment for leukemia relapse is effective i n selected cases, and exploration of pre-BMT treatment and post-BMT im munotherapy is warranted.