Abstract：
Relapse after allogeneic hematopoietic cell transplantation (allo-HCT) remains a major concern because it is associated with poor survival. A second allo-HCT is a valid option in this situation. During the 13th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to update the second allo-HCT recommendations elaborated during the previous workshop (2016). The main indication for a second allo-HCT remains relapse of initial hematologic malignancy. Disease status; complete remission (CR), and relapse time after the first allo-HCT>6 months impact positively the overall survival of patients after the second allo-HCT. Donor change is a valid option, particularly if there is HLA loss on leukemic cells after a first haploidentical or following a mismatched allo-HCT is documented. Reduced intensity conditioning is recommended, while a sequential protocol is a reasonable option in patients with proliferative disease. A post-transplant maintenance strategy after hematological recovery is recommended as soon as day 60, even if the immunosuppressive treatment has not yet been stopped. Hypomethylating agents, and targeted therapies such as anti FLT3, anti BCL2, anti-IDH1/2, TKI, anti-TP53, anti-CD33, anti-CD19, anti-CD22, anti-CD30, check point inhibitors, and CAR-T cells can be used as a bridge to transplant or as an alternative treatment to the second allo-HCT.
摘要：
异基因造血细胞移植（allo-HCT）后的复发仍然是一个主要问题，因为它与不良生存率有关。在这种情况下,第二allo-HCT是有效选项。在法语国家骨髓移植和细胞治疗协会（SFGM-TC）的第13届年度协调研讨会上，一个指定的工作组审查了文献,以更新上一次研讨会(2016年)期间提出的第二项allo-HCT建议.第二次allo-HCT的主要适应症仍然是最初的血液系统恶性肿瘤的复发。疾病状态；完全缓解（CR），首次allo-HCT>6个月后的复发时间对第二次allo-HCT后患者的总生存率有积极影响。捐赠者变更是一个有效的选择，特别是如果在首次单倍体相合或错配的allo-HCT后白血病细胞上存在HLA丢失。推荐降低强度的调理，而对于增殖性疾病患者，序贯方案是一个合理的选择。即使尚未停止免疫抑制治疗，也建议在第60天进行血液学恢复后的移植后维持策略。低甲基化剂,和靶向治疗如抗FLT3，抗BCL2，抗IDH1/2，TKI，抗TP53，抗CD33，抗CD19，抗CD22，抗CD30，检查点抑制剂，和CAR-T细胞可以用作移植的桥梁或作为第二个allo-HCT的替代治疗。
