ROLE OF 2ND BONE-MARROW TRANSPLANTS

Fifteen patients with leukaemia and myelodysplasia (n = 10) or non-mal ignant disease (5) received a second and one a third BMT following rec urrence of malignancy (7), rejection (5) or failure of engraftment (4) . Of seven patients retransplanted for relapse, 3 of 3 who were condit ioned 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 seco nd BMT relapsed. Three of these patients survive disease-free for long er than the remission after first BMT. Four patients with non-malignan t disease received a second allogeneic BMT following failure of sustai ned engraftment and three are well and disease free for 24-75 months. Five patients received an autologous rescue because of failure of sust ained engraftment. Three had sustained marrow recovery, with two patie nts 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 ma y be a suitable conditioning therapy for second BMT in patients relaps ing after BU/CY. Collection of an autologous back-up provides an addit ional safety measure in patients at increased risk of failure of susta ined engraftment.