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OBJECTIVE To improve the benefit of HSCT for the pediatric patients with recurrent or refractory acute le ukemia and MDS, we performed HSCT following the salvage chemotherapy and evaluate the efficacy and safety profile.METHODS A total of 23 consecutive pediatric patients with recurrent or refractory acute leuke mia and MDS at our center from 2013 to 2015 are analyzed.All patients were transplanted in the highrisk, relapse or refractory status.Leukemic blasts were counted in the bone marrow range from 3%-98%.All-23 patients were transplanted from haplo-identical related donors.The median age of the patients is 10 (range 1-14) years.Before the conventional regimens Bucy followed by preemptive donor lymphocyte infusion, all patient s received a course of salvage chemotherapy including fludarabine and cytarabine for 5 days.The GVHD prophyl axis consisted ofATG, CsA and MTX.None of these patients had severe infection or organ failure before HSCT.