When are second allogeneic bone marrow transplants indicated in pediatric patients?

The purpose of this study was to describe the outcomes of 22 consecutive second allogeneic bone-marrow transplantations (BMTs) in pediatric patients, in hopes of contributing to the development of guidelines for performing second BMTs. We reviewed the charts of all patients receiving a second allogeneic BMT at our center during 1974 to 1996. Patients were grouped according to reason for the second transplant: primary or secondary graft failure or disease relapse. Outcomes were compared with those of a similar group undergoing a first allogeneic BMT. Several factors identified in the Literature as contributing to a poor prognosis after second BMT, including time between transplants and reason for retransplant, were evaluated for effect on survival. Twenty-two patients undergoing second allogeneic BMT had an overall survival (OS) of 36%, and 100-day mortality of 40%, significantly worse than for first BMT patients. OS for 14 patients who received a second transplant for graft failure was 57%, and in this group, time between transplants significantly influenced OS (100% if >6 months, 33% if <6 months). Eight patients who received a second transplant for relapse had a very poor outcome, with 4 of 8 dying from regimen-related toxicity and one dying from relapse. Only 3 of these patients remain alive between 43 and 399 days after the second transplant. We conclude that second BMT has extremely high risks, especially if carried out within 6 months of the first BMT. We suggest that a second BMT is indicated in management of graft failure, but has Limited value in the management of relapse of malignant disease.