All issues > Volume 49(12); 2006

Original Article

Korean J Pediatr. 2006;49(12):1329-1339. Published online December 15, 2006.

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

Dong-Yeon DY Kim¹, Do Kyun DK Kim¹, Soo Young SY Kim¹, Seok Joo SJ Kim¹, Dong Gyun DG Han¹, Hee Jo HJ Baek¹, Hoon H Kook¹, Tai-Ju TJ Hwang¹

¹Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hwa

Correspondence Hoon H Kook ,Email: hoonKook@chonnam.ac.kr

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.

Keywords :Hematopoietic stem cell transplantation , Second transplantation , Graft failure , Relapse