Korean J Pediatr.  2006 Dec;49(12):1329-1339. 10.3345/kjp.2006.49.12.1329.

Second allogeneic hematopoietic stem cell transplantation in children to overcome graft failure or relapse after initial transplant

• Kim DY
• Kim DK
• Kim SY
• Kim SJ
• Han DG
• Baek HJ
• Kook H
• Hwang TJ

• KMID: 2278507
• DOI: http://doi.org/10.3345/kjp.2006.49.12.1329

Abstract

PURPOSE: Failure of hematopoietic stem cell transplantation(HSCT) may be encountered in practice because of either relapse of the malignancy or dysfunction of the graft. Second HSCT may be the only option for some patients whose initial HSCT failed.
METHODS
From May, 1991 to December, 2004, 115 HSCTs were performed at the Pediatric Blood & Marrow Transplantation Center, Chonnam National University. This study was a retrospective analysis of the medical records of 15 patients who received the second HSCT after initial graft.
RESULTS
Among eight patients with nonmalignant diseases, two patients underwent the second HSCT because of primary graft failure and five because of late graft rejection. The remaining Fanconi anemia patient was re-transplanted due to development of AML. Two patients died and one experienced primary graft failure, but is still alive. The Kaplan-Meier 5-year overall survival rate was 75 percent and the disease free survival rate was 62.5 percent in nonmalignant diseases. All malignant patients underwent second transplants because of relapses. Four died of relapse and one of treatment-related complications. The Kaplan-Meier 2-year overall and event free survival rate was 28.6 percent each in malignant diseases.
CONCLUSION
Second HSCT for graft dysfunction of nonmalignant disease seems to be feasible and should be considered as a standard practice. The relapse of malignant diseases remains a big obstacle even after the second HSCT, although a small portion of patients might be salvaged. Further investigation of novel therapeutic strategies, as well an the understanding of the biology should be explored.

Keyword

Hematopoietic stem cell transplantation; Second transplantation; Graft failure; Relapse

MeSH Terms

Biology
Bone Marrow
Disease-Free Survival
Fanconi Anemia
Graft Rejection
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Jeollanam-do
Medical Records
Recurrence*
Retrospective Studies
Survival Rate
Transplants*