A Retrospective Review of the Outcome after Second or Subsequent Allogeneic Transplantation

Meirav Kedmi, Igor B. Resnick, Liliane Dray, Memet Aker, Simcha Samuel, Benjamin Gesundheit, Shimon Slavin, Reuven Or, Michael Y. Shapira

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

The failure of allogeneic stem cell transplant (allo-SCT) is cumbersome. We analyzed our experience in a second allo-SCT. Between the years 1981 and 2007, 144 patients underwent 2 or more allo-SCT. The first to second transplant interval ranged from 18 days to 13.25 years (median 98 days). The most frequent indications for the second SCT were activity of the basic disease (78), rejection (37), and engraftment failure (25). Twenty-nine of the 144 (20%) patients transplanted survived more then a year with treatment-related mortality of 45.5% as the leading cause of death. Interestingly, despite the low rate of graft-versus-host disease (GVHD) prophylaxis used, only 51 and 16 of the patients developed acute and chronic GVHD (aGVHD, cGVHD), respectively. Factors indicating higher likelihood for survival were nonmalignant disease, a nonrelapse indication for the second SCT, full HLA-matching, and the use of reduced-intensity conditioning (RIC). Age at transplantation, time interval between transplants, the development of GVHD, conditioning regimen, GVHD prophylaxis, or graft source were not shown to influence the prognosis. With a median follow-up of 4.5 years, 25 patients (17.2%) are alive, and 18 are disease-free. We conclude that although toxic, a second allo-SCT can lead to long-term survival.

Original languageEnglish
Pages (from-to)483-489
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

Keywords

  • Allogeneic bone marrow transplantation
  • Engraftment failure
  • GVHD
  • Graft rejection
  • Relapse
  • Toxicity

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