Outcomes following second allogeneic haematopoietic transplants using fludarabine-melphalan conditioning.

Second allogeneic haematopoietic cell transplant (allo-HCT2) after first allograft offers the possibility of long-term survival after relapse;1, 2, 3, 4 however, the optimal donor choice and conditioning strategy remain to be defined. All published series are retrospective and include a variety of conditioning regimens. The role of the conditioning regimen in allo-HCT2 outcomes is difficult to determine as the majority of the survival effect is thought to relate to GVL; however, recent studies have demonstrated that reduced-intensity conditioning (RIC) has improved outcomes compared with myeloablative conditioning (MAC) owing to a reduction in toxicity.5, 6 No series has reported the outcomes in patients conditioned purely with fludarabine–melphalan (Flu-Mel), which is presently the commonest RIC regimen used in Australasia.7 Here, we report a series of patients receiving allo-HCT2 using Flu-Mel conditioning. Cumulative incidence curves were constructed with appropriate events as competing risks. Survival probabilities used the Kaplan–Meier method. Multivariate analysis was performed using Cox regression.