Second allogeneic hematopoietic stem cell transplantation (allo-HSCT) has a low survival outcome and a high non-relapse mortality (NRM) rate which is a major obstacle to this treatment. We hypothesized that the status of malnourishment after first allo-HSCT as represented by the geriatric nutritional risk index (GNRI) could be used as a prognostic factor to determine the outcomes of second allo-HSCT. A total of 108 patients with a median age of 42 (range, 17–69) years, who received second allo-HSCT for disease recurrence after first allo-HSCT from our institution, were included in this study. Low GNRI had a significant impact on NRM at 2 years after second allo-HSCT: 56.9% in patients with GNRI ≤ 92 compared with 27.5% in patients with GNRI > 92 (P = 0.002). In multivariate analysis, GNRI of ≤ 92 was the only significant factor for NRM (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.15–4.56, P = 0.018). High-risk disease status at second allo-HSCT (HR 2.74, 95% CI 1.46–5.14, P = 0.002) and GNRI of ≤ 92 (HR 1.70, 95% CI 1.02–2.82, P = 0.042) were identified as significant factors for overall survival (OS). A score of 1 was assigned to each factor, and the OS rate at 2 years after second allo-HSCT decreased according to the score: 53.0% in patients with score 0, 32.3% with score 1, and 2.5% with score 2 (P < 0.001). In conclusion, GNRI could be a useful predictor for the outcomes of second allo-HSCT. A prospective study in other cohorts is warranted to validate the findings of our study.

第二次异基因造血干细胞移植 (allo-HSCT) 的存活率低，非复发死亡率 (NRM) 高，这是该治疗的主要障碍。我们假设以老年营养风险指数 (GNRI) 为代表的第一次异基因造血干细胞移植后的营养不良状况可用作确定第二次异基因造血干细胞移植结果的预后因素。本研究共纳入 108 名中位年龄为 42（范围，17-69）岁的患者，他们在我们机构的第一次异基因造血干细胞移植后接受了第二次异基因造血干细胞移植治疗疾病复发。第二次异基因造血干细胞移植后 2 年，低 GNRI 对 NRM 有显着影响：GNRI ≤ 92 的患者为 56.9%，而 GNRI > 92 的患者为 27.5%（P = 0.002）。在多变量分析中，≤ 92 的 GNRI 是 NRM 的唯一重要因素（风险比 [HR] 2.29，95% 置信区间 [CI] 1.15-4.56，P  = 0.018）。第二次 allo-HSCT 时的高危疾病状态（HR 2.74，95% CI 1.46-5.14，P  = 0.002）和 GNRI ≤ 92（HR 1.70，95% CI 1.02-2.82，P  = 0.042）被确定为重要因素总生存期 (OS)。每个因素计1分，第二次allo-HSCT后2年OS率根据评分下降：0分53.0%，1分32.3%，2分2.5%（P < 0.001)。总之，GNRI 可能是第二次异基因造血干细胞移植结果的有用预测指标。需要在其他队列中进行前瞻性研究来验证我们的研究结果。