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Second hematopoietic stem cell transplantation in myeloid malignancies

Arfons, Lisa Ma; Tomblyn, Marcieb; Rocha, Vandersonc; Lazarus, Hillard Ma

Current Opinion in Hematology: March 2009 - Volume 16 - Issue 2 - p 112–123
doi: 10.1097/MOH.0b013e3283257a87
Myeloid disease: Edited by Martin S. Tallman

Purpose of review: Hematopoietic stem cell and umbilical cord blood transplantation can be a life-saving procedure for many patients with myeloid malignancies. The posttransplant period, however, can be complicated by graft failure and disease relapse, prompting the need for further therapy. Herein, we review and examine the data of second allogeneic stem cell transplant after autologous, allogeneic and umbilical cord blood transplantation.

Recent findings: Although large, prospective, multicenter trials are lacking, certain factors such as younger patient age, lower disease burden and a longer interval between first transplantation and relapse appear to portend a better prognosis for second transplant.

Summary: Currently, only a selected group of patients without important comorbidities should be considered for second allogeneic transplantation. Strategies such as new immunosuppressive agents, antileukemia monoclonal antibodies, graft modification and use of molecularly targeted therapy are needed to decrease the morbidity and increase the efficacy of transplantation.

aDepartment of Medicine, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio, USA

bAdult Blood and Marrow Transplant Program, Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA

cHematology Bone Marrow Transplant Department, Hôpital Saint-Louis, Acute Leukemia Working Party of European Group for Blood and Marrow Transplantation and Eurocord, Paris, France

Correspondence to Hillard M. Lazarus, MD, FACP, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA Tel: +1 216 844 3629; fax: +1 216 844 5979; e-mail: hillard.lazarus@case.edu

© 2009 Lippincott Williams & Wilkins, Inc.