Second Hematopoietic Stem Cell Transplantation in Pediatric Patients
Second Hematopoietic Stem Cell Transplantation in Pediatric Patients:
Overall Survival and Long-term Follow-up
Ami J. Shah, Neena Kapoor, Kenneth I. Weinberg, Gay M. Crooks, Donald B.
Kohn, Carl Lenarsky, Francine Kaufman, Karen Epport, Kathy Wilson,
Robertson Parkman
Biology of Blood and Marrow Transplantation 8:221-228 (2002)
© 2002
American Society for Blood and Marrow Transplantation
ABSTRACT:
Despite potent intensive conditioning regimens, hematopoietic stem cell
transplantation (HSCT) may fail because of either relapse of the
malignancy or the rejection of the graft. We report on 27 pediatric
patients who received a second HSCT from an allogeneic donor for
relapsed malignancy or graft failure. One-year, 5-year, and 10-year
probabilities of survival for all patients were 53%, 36%, and 24%,
respectively. Twenty patients received second HSCTs for relapsed
malignancy, of whom 6 were alive and disease free at the time of this
report. Seven patients received a second HSCT for graft failure, of whom
3 were alive and well as of this report. Twenty-five patients were
tested for immune reconstitution following their second HSCT. Sixteen
patients developed antigen-specific T-lymphocyte responses; the median
time to development of antigen-specific responses was 13 months. There
was no significant neurocognitive decline in patients tested 1 to 3
years following their second HSCT. Endocrine evaluations revealed
deficiencies in growth hormone (7 patients), gonadal function (3
patients), and thyroid function (2 patients). Three patients developed
significant abnormalities of tooth development, including absence of
secondary teeth. These results show that a second HSCT offers curative
therapy for selected pediatric patients whose first HSCT failed.
Although toxicity is considerable following a second transplantation,
the major causes of mortality continue to be relapse and infection.
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