Second allogeneic stem cell transplantation (alloSCT2) is among the most effective treatments for acute myeloid leukemia (AML) relapse after first alloSCT (alloSCT1). Long-term EBMT registry data were used to provide large scale, up-to-date outcome results and to identify factors for improved outcome. Among 1540 recipients of alloSCT2, increasing age, better disease control and performance status before alloSCT2, more use of alternative donors and higher conditioning intensity represented important trends over time. Between the first (2000–2004) and last (2015–2019) period, two-year overall and leukemia-free survival (OS/LFS) increased considerably (OS: 22.5–35%, LFS: 14.5–24.5%). Cumulative relapse incidence (RI) decreased from 64% to 50.7%, whereas graft-versus-host disease and non-relapse mortality (NRM) remained unchanged. In multivariable analysis, later period of alloSCT2 was associated with improved OS/LFS (HR = 0.47/0.53) and reduced RI (HR = 0.44). Beyond, remission duration, disease stage and patient performance score were factors for OS, LFS, RI, and NRM. Myeloablative conditioning for alloSCT2 decreased RI without increasing NRM, leading to improved OS/LFS. Haploidentical or unrelated donors and older age were associated with higher NRM and inferior OS. In summary, outcome after alloSCT2 has continuously improved over the last two decades despite increasing patient age. The identified factors provide clues for the optimized implementation of alloSCT2.

第二次同种异体干细胞移植 (alloSCT2) 是治疗首次 alloSCT (alloSCT1) 后急性髓系白血病 (AML) 复发的最有效治疗方法之一。长期 EBMT 注册数据用于提供大规模、最新的结果结果，并确定改善结果的因素。在 1540 名 alloSCT2 接受者中，随着时间的推移，年龄的增加、alloSCT2 之前更好的疾病控制和体能状态、更多地使用替代供体和更高的调节强度代表了重要的趋势。在第一个时期（2000-2004年）和最后一个时期（2015-2019年）之间，两年总体生存率和无白血病生存率（OS/LFS）显着增加（OS：22.5-35％，LFS：14.5-24.5％）。累积复发率（RI）从 64% 下降至 50.7%，而移植物抗宿主病和非复发死亡率（NRM）保持不变。在多变量分析中，alloSCT2 的后期与 OS/LFS 改善（HR = 0.47/0.53）和 RI 降低（HR = 0.44）相关。此外，缓解持续时间、疾病阶段和患者表现评分也是 OS、LFS、RI 和 NRM 的因素。 alloSCT2 的清髓调节可降低 RI，而不增加 NRM，从而改善 OS/LFS。单倍体或不相关的供体和年龄较大与较高的 NRM 和较低的 OS 相关。总之，尽管患者年龄不断增加，但 alloSCT2 后的结果在过去二十年中不断改善。确定的因素为alloSCT2的优化实施提供了线索。