Second hematopoietic stem cell transplantation (HSCT) may be an effective salvage therapy in some patients with acute myelogenous leukemia (AML) who relapse after an initial transplant. To investigate the availability of second HSCT, we reviewed our medical records of 10 recipients of second allogeneic transplants for leukemia recurring after initial autologous or allogeneic transplantation. Since year 2002, ten relapsed patients after first HSCT who received second HSCT from the available HLA-matched (N = 7) or –mismatched (N = 3) sibling or unrelated donors were retrospectively reviewed. The median patient age was 35 (range, 18∼51) and there were 6 males and 4 females. The median follow-up duration after second transplant was 14 months (range, 4–59). The majority of patients had intermediate or unfavourable cytogenetic features. Seven patients were relapsed after autologous HSCT, as a first transplant. Others received from HLA-matched sibling donors. The main conditioning regimen for second transplant consisted in cyclophosphamide plus busulfan. For graft-versus-host-disease (GVHD) prophylaxis, we used combinations of cyclosporine A or tacrolimus in addition to short-term methotrexate. In all, 6 patients received peripheral blood stem cells. All transplanted patients were successfully engrafted. The overall incidence of acute and chronic GvHD was 60% and 43%, respectively. Two (20%) patients were relapsed so far. The estimated probability of disease-free survival rate at 4-year was 50%. The overall 5-year survival rate was 55%. When we considered the incidence of non-relapse transplant-related mortality (TRM), two recipients (20%) died due to one from severe acute GvHD and the other from fatal infectious cause. These results demonstrate that second HSCT for relapsed AML patients performed with appropriate clinical schedule is feasible, and is associated with a favourable outcome.Tabled 1Characteristics of patientsDiagnosisAge/SexCytogenetics1st transplant2nd transplantStem cell sourceConditioningStatusAML, M133/F46 XXSib alloSib alloPBSCBusulfex/CyAlive, 50 mAML, M136/Mt(8;21),21q,+4AutoUnrelatedPBSCBusulfex/Cy/ATGDied, 4 mAML, M235/Minv(16)AutoSib alloPBSCBusulfex/CyAlive, 11 mAML, M446/M46 XYSib alloSib alloPBSCBusulfex/CyAlive, 53 mAML, M249/F45 X,-9AutoUnrelatedBMBusulfex/Cy/ATGAlive, 19 mAML, M244/Ft(1;1)AutoUnrelatedBMBusulfex/CyAlive, 59 mAML, M235/Mdel(16)AutoUnrelatedBMBusulfex/Cy/ATGDied, 12 mAML, M121/Finv(16)AutoSib alloBMBusulfex/CyDied, 6 mAML, M534/M47 XX,+21, add(3), add(15), t(4;18)Sib alloSib alloPBSCBusulfex/Fludarabine/Ara-CAlive, 6 mAML, M118/F47 XX,+21AutoSib alloPBSCBusulfex/CyDied, 24 mIDA/BHAC, idarubicin/N4-behenoyl-1-b-Darabinofuranosylcytosine; FLANG, fludarabine, Ara-C, mitoxantrone, and G-CSF combination chemotherapy in a sequence manner; Topo, topotecan; M, mitoxantrone; Vp, etoposide; Cy, cyclophosphamide; ATG, anti-thymocyte globulin; TRM, transplant-related mortality; CR2, second complete remission; CTx, chemotherapy; F/U, follow-up. Open table in a new tab IDA/BHAC, idarubicin/N4-behenoyl-1-b-Darabinofuranosylcytosine; FLANG, fludarabine, Ara-C, mitoxantrone, and G-CSF combination chemotherapy in a sequence manner; Topo, topotecan; M, mitoxantrone; Vp, etoposide; Cy, cyclophosphamide; ATG, anti-thymocyte globulin; TRM, transplant-related mortality; CR2, second complete remission; CTx, chemotherapy; F/U, follow-up.