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Abstract：
Management of relapsed leukemia following allogeneic transplantation is challenging. Intensive chemotherapy, donor lymphocyte infusions (DLI), or second transplantation have some value, but most reported series describe only a limited number of patients surviving beyond 2 or 3 years following relapse. Additionally, understandable selection-bias of reports describing the outcomes of intensive management approaches for relapsed leukemia confound generalizability to a broader population. However numerous reports suggest that second allogeneic transplantation for relapsed leukemia following an initial transplant may produce extended disease control and survival for patients with favorable performance status, remission at the time of second transplant, and most importantly a long interval between initial transplant and relapse. Reduced intensity conditioning for second allografts may be preferable and little data exists to suggest that a new donor will improve disease control by inducing a stronger graft-versus-leukemia effect. Improved measures to prevent the first relapse, however, may protect more patients and produce a greater fraction enjoying extended leukemia-free survival.
摘要：
同种异体移植后复发性白血病的治疗具有挑战性。强化化疗,供体淋巴细胞输注（DLI），或者第二次移植有一定的价值，但大多数报道的系列仅描述了有限数量的患者在复发后存活超过2或3年.此外,可理解的选择偏倚性报告描述了复发性白血病强化治疗方法的结果，这使得对更广泛的人群具有普遍性。然而，许多报道表明，初次移植后的复发性白血病的第二次同种异体移植可能会对具有良好表现状态的患者产生延长的疾病控制和存活。在第二次移植时缓解，最重要的是，初次移植和复发之间有很长的间隔。降低二次同种异体移植物的强度调节可能是优选的，并且几乎没有数据表明新的供体将通过诱导更强的移植物抗白血病作用来改善疾病控制。改进防止首次复发的措施,然而,可以保护更多的患者，并产生更大的部分享受延长的无白血病生存。
