Yafour Nabil, Couturier Marie Anne, Azarnoush Saba, Girault Stéphane, Hermet Eric, Masouridi Levrat Stavroula, Schmidt Aline, Michallet Mauricette, Etancelin Pascaline, Guillaume Thierry, Malard Florent, Sirvent Anne, Yakoub-Agha Ibrahim, Poiré Xavier
Établissement Hospitalier et Universitaire 1er-Novembre 1954, service d'hématologie et de thérapie cellulaire, BP 4166, 31000 Ibn Rochd, Oran, Algérie; Université d'Oran 1, Ahmed Ben Bella, faculté de médecine, Oran, Algérie.
Hôpital Morvan, institut cancérologie-hématologie, CHRU Brest, 2, avenue Foch, 29200 Brest, France.
Bull Cancer. 2019 Jan;106(1S):S40-S51. doi: 10.1016/j.bulcan.2018.05.018. Epub 2018 Nov 6.
Disease recurrence and graft dysfunction after allogeneic hematopoietic stem cell transplantation (allo-HSCT) currently remain among the major causes of treatment failure in malignant and non-malignant hematological diseases. A second allo-HSCT is a valuable therapeutic option to salvage those situations. During the 8th annual harmonization workshops of the french Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines on feasibility, indications, donor choice and conditioning in the case of a second allo-HSCT. In case of relapse, a second allo-HSCT with reduced intensity or non-myeloablative conditioning is a reasonable option, particularly in patients with a good performance status (Karnofsky/Lansky>80%), low co-morbidity score (EBMT score≤3), a longer remission duration after the first allo-HSCT (>6 months), and who present low disease burden at the time of second allo-HSCT. Matched related donors tend to be associated with better outcomes. In the presence of graft dysfunction (primary and secondary graft rejection), an immunoablative conditioning regimen is recommended. A donor change remains a valid option, especially in the absence of graft-versus-host disease after the first allo-HSCT.
异基因造血干细胞移植（allo-HSCT）后的疾病复发和移植物功能障碍目前仍是恶性和非恶性血液系统疾病治疗失败的主要原因。二次allo-HSCT是挽救这些情况的一种有价值的治疗选择。在法国骨髓移植和细胞治疗协会（SFGM-TC）第8届年度协调研讨会上，一个指定的工作组回顾了文献，以便制定关于二次allo-HSCT的可行性、适应症、供体选择和预处理的统一指南。在复发的情况下，采用降低强度或非清髓性预处理进行二次allo-HSCT是一个合理的选择，特别是对于那些身体状况良好（卡诺夫斯基/兰斯基评分>80%）、合并症评分低（欧洲血液和骨髓移植协会评分≤3）、首次allo-HSCT后缓解期较长（>6个月）且在二次allo-HSCT时疾病负担较低的患者。匹配的相关供体往往与更好的结果相关。在存在移植物功能障碍（原发性和继发性移植物排斥）的情况下，建议采用免疫清除预处理方案。更换供体仍然是一个有效的选择，特别是在首次allo-HSCT后没有移植物抗宿主病的情况下。
