Second allogeneic haematopoietic stem cell transplantation in relapsed acute and chronic leukaemias for patients who underwent a first allogeneic bone marrow transplantation: a survey of the Societe Francaise de Greffe de Moelle (SFGM)

Although recurrent malignancy is the most frequent indication for second st em cell transplantation (2nd SCT), there are few reports that include suffi ciently large numbers of patients to enable prognostic factor analysis. Thi s retrospective study includes 150 patients who underwent a 2nd SCT for rel apsed acute myeloblastic leukaemia (n = 61), acute lymphoblastic leukaemia (n = 47) or chronic myeloid leukaemia (n = 42) after a first allogeneic tra nsplant (including 26 T-cell-depleted). The median interval between the fir st transplant and relapse, and between relapse and second transplant was 17 months and 5 months respectively. After the 2nd SCT, engraftment-occurred in 93% of cases, 32% of patients developed acute graft-vs.-host disease (GV HD) greater than or equal to grade II and 38% chronic GVHD. The 5-year over all and disease-free survival were 32 +/- 8% and 30 +/- 8%, respectively wi th a risk of relapse of 44 +/- 12% and a transplant-related mortality of 45 +/- 9%. In a multivariate analysis, ave factors were associated with a bet ter outcome after 2nd SCT: age <16 years at second transplant; relapse occu rring more than 12 months after the first transplant: transplantation from a female donor: absence of acute GVHD; and the occurrence of chronic GVHD. The best candidates for a second transplant are likely to be patients with acute leukaemia, in remission before transplant, in whom the HLA-identical donor was female and who relapsed more than 1 year after the first transpla nt.