Allogeneic bone marrow transplant or second autograft in patients with acute leukemia who relapse after an autograft

Among 2752 patients with acute leukemia who had recurrent leukemia after au tograft in remission and were reported to the EBMT, 94 underwent an allogen eic bone marrow transplant and 74 received a second autograft. Recipients o f HLA-mismatched related or unrelated bone marrow had an increased transpla nt-related mortality (TRM, P = 0.017) and a decreased leukemia-free surviva l (LFS, P = 0.03), compared to recipients of HLA matched related or unrelat ed bone marrow. Outcome in recipients of HLA-compatible related or unrelate d bone marrow was compared to those receiving a second autograft, TRM at 2 years was 51 +/- 8% in recipients of matched allografts and 26 +/- 6% follo wing a 2nd autograft (P < 0.05), Two-gear LFS was 27 +/- 7% and 35 +/- 6% i n the two groups, respectively (NS), Multivariate analysis in these two gro ups showed that TRM was increased in patients who were in 2nd or later remi ssion at Ist autograft (P < 0.05) and allograft recipients (P < 0.05), Rela pse was more common in patients with ALL (P < 0.001), above 25 years of age (P < 0.02), autograft performed later than 1991 (P < 0.05), and in second autografts (P < 0.05), LFS was decreased in patients >25 years of age (P < 0.01), if the interval from first autograft to relapse was 8 months or less (P < 0.01) and if TBI was used at first autograft (P < 0.05).