Second early allogeneic stem cell transplantations for graft failure in acute leukaemia, chronic myeloid leukaemia and aplastic anaemia

In this retrospective multicentre study, we analysed the results of 82 cons ecutive second early allogeneic transplants for primary (n = 28) or seconda ry (n = 54) graft failures performed between 1985 and 1997 in patients with acute leukaemia (n = 33), aplastic anaemia in = 29) or chronic myeloid leu kaemia (n = 20). HLA-matched siblings were used in 64 cases. The same donor s were used for both transplants in 56 cases and the first transplant was T -cell depleted in 30 cases. The median age at transplant was 25 years and t he median intertransplant time internal was 2 months. Estimates of the 3-ye ar overall survival and day 100 transplant-related mortality were 30% and 5 3% respectively. A recipient age < 34 years at transplant, an intertranspla nt time interval <greater than or equal to> 80 d and a positive recipient c ytomegalovirus serology were predictors of a better outcome. The use of cyc losporin A (CsA) after second transplant had a dramatic impact on outcome, the best results being observed with CsA alone. The day 40 probability of n eutrophil recovery was 73%. The use of peripheral blood progenitor cells (P BPCs) was associated with a higher and faster neutrophil recovery. Other fa ctors associated with neutrophil recovery were an intertransplant time inte rval greater than or equal to 80 d and a positive recipient cytomegalovirus serology, Therefore, second early allogeneic transplantation for graft fai lure is an effective treatment, especially if patients can receive CsA for graft-versus-host disease prevention and are retransplanted more than 80 d from first transplant.