2ND ALLOGENEIC BONE-MARROW TRANSPLANTATION IN ACUTE-LEUKEMIA - A MULTICENTER STUDY FROM THE GRUPPO-ITALIANO-TRAPIANTO-DI-MIDOLLO-OSSEO (GITMO)

Thirty-eight second allogeneic bone marrow transplants (BMT) for acute leukemia relapsed after first BMT were performed in 13 Italian center s between 1987 and 1994. Twenty-one patients had acute myelogenous leu kemia (AML), 17 acute lymphoblastic leukemia (ALL); at second BMT 24 p atients were in complete remission (CR) and 14 in relapse. The median time to relapse after first BMT was 10 months (range 1-70). Grade II o r greater acute graft-versus-host disease (GVHD) after second transpla nt occurred in 34.2% of patients and a chronic GVHD in 31.5% of patien ts. Twenty-four patients died: seven from early transplant-related mor tality (IRM), 13 from relapse and four from late toxicity. As of 31 Ju ly 1996, at a median follow-up of 47 months (range 22-85), there are 1 4 survivors. The three-year probability of TRM, relapse and event-free survival (EFS) is 28%, 40% and 42% respectively. In 20 of 27 evaluabl e patients, remission duration after second BMT was longer than after the first BMT. A diagnosis of AML was correlated with a better outcome . These data support the usefulness of second allograft in selected pa tients with AML relapsing after a first BMT.