OUTCOME OF ACUTE-LEUKEMIA RELAPSING AFTER BONE-MARROW TRANSPLANTATION- UTILITY OF 2ND TRANSPLANTS AND ADOPTIVE IMMUNOTHERAPY

We studied 231 acute leukemia patients relapsing after allogeneic (n = 114) or autologous (n = 117) BMT to assess the outcome of further the rapy, In general, all patients in good condition were eligible for sec ond transplants except for post-allograft relapses from 1993-1994 onwa rds who received cytokine- or cell-mediated immunotherapy. The major r eason for patients not progressing to second graft was death from prog ressive disease or toxicity of salvage chemotherapy, Seventeen of 231 patients (7%) were alive at the last follow-up, Six of 14 post-autogra ft relapses treated with second transplants were alive and well, compa red with five of 103 not undergoing second grafts (P < 0.0001), One of 23 post-allograft recipients treated with second allografts was alive with an extramedullary relapse, compared with five of 13 receiving im munotherapy and none of 78 receiving standard-dose or palliative thera py (P < 0.0001), We conclude that only a small proportion of highly se lected acute leukemia patients relapsing after a transplant reach the stage of a conventional second transplant, In our experience, second a llografts after myeloablative therapy in patients relapsing after one allograft are associated with very poor results, and immunotherapy may be a better approach in such cases, Selected patients relapsing after an autograft may become long-term survivors following a second autogr aft or an allograft.