Second allogeneic bone marrow transplantation in acute leukemia: Results of a survey by the European Cooperative Group for Blood and Marrow Transplantation

Purpose: Leukemic relapse is the most frequent cause of treatment failure a fter allogeneic hematopoietic stem-cell transplantation (HSCT). To identify prognostic factors affecting the outcome of second HSCT, we performed a re trospective study on patients with acute leukemia (AL) undergoing second HS CT who reported to the Acute Leukemia Working Party of the European Coopera tive Group for Blood and Marrow Transplantation registry. Patients and Methods: One hundred seventy patients who received second HSCT s for AL experienced relapse after first HSCTs were performed from 1978 to 1997. Status at second HSCT, time between first and second HSCT, conditioni ng regimen, source of stem cells, treatment-related mortality (TRM), acute graft-versus-host disease (aGVHD), leukemia-free survival (LFS), overall su rvival (OS), and relapse were considered. Results: Engraftment occurred in 97% of patients. Forty-two patients were a live at last follow-up, with a 5-year OS rate of 26%. The 5-year probabilit y for TRM, LFS, and relapse was 46%, 25%, and 59%, respectively. Grade grea ter than or equal to 2 aGVHD occurred in 59% of patients, and chronic GVHD occurred in 32%. In multivariate analysis, diagnosis, interval to relapse a fter first HSCT > 292 days, aGVHD at first HSCT, complete remission status at second HSCT, use of total-body irradiation at second HSCT, acute GVHD at second HSCT, and use of bone marrow as source of stem cells at second HSCT were associated with better outcome. Conclusion: Second HSCT represents an effective therapeutic option for AL p atients relapsed after allogeneic HSCT, with a 3-year LFS rate of 52% for t he subset of patients who experienced relapse more than 292 days after rece iving the first HSCT and who were in remission before receiving the second HSCT. J Clin Oncol 19:3675-3684. (C) 2001 by American Society of Clinical Oncolog y.