Effects of second transplantation with T-cell-replete haploidentical graft using low-dose anti-thymocyte globulin on long-term overall survival in pediatric patients with relapse of leukemia after first allogeneic transplantation

Int J Hematol. 2022 Mar;115(3):414-423. doi: 10.1007/s12185-021-03266-9. Epub 2021 Nov 25.


Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the preferred treatment for children with high-risk hematologic malignancies, but post-allo-HSCT relapse has a poor prognosis and limited treatment options. We evaluated the feasibility, outcome, and risk factors influencing survival after T-cell-replete haploidentical HSCT with low-dose anti-thymocyte globulin (ATG) in 30 patients with post-allo-HSCT relapse of acute lymphoblastic leukemia and acute myeloid leukemia. Overall, 50% of the patients had complete remission (CR) before the second transplant and the overall survival (OS) rate was 52%. In surviving patients (median follow-up 614 days), Kaplan-Meier analysis revealed estimated 2-year leukemia-free survival and OS rates of 48.1% and 61.1%, respectively. Cumulative incidences of 2-year non-relapse mortality and relapse were 24.7% and 36.3%, respectively. Achieving CR before the second allo-HSCT was a predominant independent prognostic factor identified in the multivariate analysis, with a significantly improved 2-year OS rate of 86.7%. T-cell-replete haplo-HSCT with low-dose ATG for second allo-HSCT may benefit a selected patient population.

Keywords: Acute leukemia; Children; Haploidentical hematopoietic stem cell transplantation; Post-transplantation relapse; Second transplantation.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Antilymphocyte Serum / administration & dosage*
  • Child
  • Child, Preschool
  • Feasibility Studies
  • Female
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Humans
  • Infant
  • Leukemia, Myeloid, Acute / mortality
  • Leukemia, Myeloid, Acute / surgery*
  • Male
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / surgery*
  • Recurrence
  • Reoperation / methods*
  • Survival Rate
  • T-Lymphocytes / transplantation*
  • Time Factors
  • Transplantation Conditioning / methods*
  • Transplantation, Homologous*
  • Treatment Outcome
  • Young Adult


  • Antilymphocyte Serum