Objective  To explore the secondary transplantation strategy for graft failure of the primary haploidentical hematopoietic stem cell transplantation (haplo-SCT) associated with fatal complications in a patient with acute T-cell lymphocytic leukemia.

  Methods  One male patient was diagnosed with acute T-cell lymphocytic leukemia. In November 2015, he received haplo-SCT from his sister as the donor. But graft failure was developed and complicated by Escherichia coli sepsis, serum disease, hepatic venous occlusion and multiple organ failure. At 32^nd d after the first transplantation, secondary haplo-SCT from his father as the donor was performed. Prior to secondary transplantation, chemotherapy pretreatment was not conducted. Post-transplantation cyclophosphamide (PTCy)-based prevention measure against the graft-versus-host disease (GVHD) was adopted after transplantation.

  Results  White blood cells were implanted on the 12nd d and platelet implantation was performed on the 67th d after haplo-SCT. Serum disease, septicemia and hepatic venous occlusion were cured and organ function was improved. However, the patient died from the recurrence of leukemia at 18^th months after transplantation (June 2017).

  Conclusions  Prior to secondary haplo-SCT, PTCy prevention measures against the GVHD rather than pretreated chemotherapy probably contributes to the success of transplantation.