Haploidentical transplants for patients with graft failure after the first allograft

Kongtim, Piyanuch; Bittencourt, Maria Cecilia Borges; Srour, Samer A.; Ramdial, Jeremy; Rondón, Gabriela; Chen, Julianne; Khouri, Issa F.; Oran, Betül; Popat, Uday; Olson, Amanda; Bashir, Qaiser; Shpall, Elizabeth J.; Kebriaei, Partow; Champlin, Richard E.; Ciurea, Stefan O.

doi:10.1002/ajh.25917

Cited by 6 publications

(8 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A dismal 2-years OS (18.5%) was observed, due to a high TRM rate reaching 55.8%, which may be explained by an accumulation of toxicities from conditioning regimens, associated with a high infectious risk and complications related to several weeks or months duration of pancytopenia. These results are in line with ones published by Kongtim et al, 25 reporting a 59% 1-year NRM and a 22% 3-years OS in 31 patients receiving a salvage haplo-HSCT for graft failure. In the context of salvage HSCT for disease relapse, outcomes were also very similar to the literature (14% 2-years OS in 25 patients after salvage haplo-transplant in Haen et al 26 ).…”

Section: Discussionsupporting

confidence: 92%

Salvage haploidentical or cord‐blood allogeneic stem cell transplantation after a prior alternative allograft in hematologic malignancies: A retrospective study from the SFGM‐TC

Cavalieri

Rubio

Corriger

et al. 2022

European J of Haematology

View full text Add to dashboard Cite

Background: Haploidentical (haplo-) donors and cord-blood (CB) stem cells provide alternative transplant options in patients lacking an HLA-matched donor. In case of relapse or graft failure after a first alternative allogeneic hematopoietic stem cell transplant (HSCT), a second alternative HSCT (HSCT2) is rarely considered due to a high risk of toxicity.Methods: A retrospective French multicentre study was performed, including patients with hematologic malignancies who underwent two consecutive HSCT from alternative donors. All data were exported from the national ProMISE database between 2000 and 2016.Results: Forty-three patients (61.4%) received a CB-HSCT2 and 27 (38.6%) a haplo-HSCT2. Indications for HSCT were graft failure (51.4%) or disease progression (48.6%). Two-years probabilities of overall survival, progression-free survival and toxicity-related

show abstract

Section: Discussionsupporting

confidence: 92%

Salvage haploidentical or cord‐blood allogeneic stem cell transplantation after a prior alternative allograft in hematologic malignancies: A retrospective study from the SFGM‐TC

Cavalieri

Rubio

Corriger

et al. 2022

European J of Haematology

View full text Add to dashboard Cite

show abstract

“…In the current study, we demonstrated that a transplantation with a reduced-intensity fludarabine and cyclophosphamide (Flu/Cy) conditioning regimen from different HIDs provides a very successful salvage for patients with GF after stem cell transplantation. Previous reports of salvage haploidentical stem cell transplantation were of small patient populations and case series, and importantly, most were retrospective and heterogenous in terms of conditioning regimens and protocol (13)(14)(15)(16)(17)(18)(19)(20)(21). To the best of our knowledge, this is the first prospective study investigating salvage haploidentical transplantation in patients with GF.…”

Section: Discussionmentioning

confidence: 98%

“…However, all seven of those patients died of NRM, while all of the patients with different donors engrafted successfully. Changing to a different donor might be one of the important features of a successful engraftment (21). Furthermore, using an initial donor in a very short period might increase the risk for re-collection with the initial donor.…”

Section: Discussionmentioning

confidence: 99%

Graft Failure in Patients With Hematological Malignancies: A Successful Salvage With a Second Transplantation From a Different Haploidentical Donor

Sun

Wang

et al. 2021

Front. Med.

View full text Add to dashboard Cite

Graft failure (GF) is a fatal complication of allogeneic stem cell transplantation, especially after haploidentical transplantation. The mortality of GF is nearly 100% without an effective salvage method. A second transplantation is usually necessary to save the patient's life. However, there is no standardized regimen, and the outcome is usually disappointing. We report on a prospective single-center study using a reduced-intensity conditioning regimen with different haploidentical donors (HIDs). Patients with GF after the first transplantation were enrolled in a prospective single-arm clinical trial (ClinicalTrials.Gov ID: NCT03717545) at the Peking University Institute of Hematology. The conditioning regimen consisted of fludarabine (30 mg/m2) (days−6 to−2) and cyclophosphamide (1,000 mg/m2/day) (days−5 to−4). Patients underwent a second transplant from a different HID using a granulocyte colony-stimulating factor primed bone marrow and peripheral blood stem cells. The primary outcome was neutrophil engraftment at day 28. The secondary outcomes included platelet engraftment at day 100, transplant-related mortality (TRM) at day 30, TRM at day 100, and overall survival (OS) at 1 year. From March 2018 to June 2020, 13 patients were enrolled in this clinical trial. Of the 13 patients, five had acute myeloid leukemia, five had acute lymphoblastic leukemia, two had myelodysplastic syndromes, and one had a non-Hodgkin lymphoma. The median age at first transplantation was 38 years (range, 8–55 years). As for the first transplantation, 11 patients underwent haploidentical transplantations and two underwent unrelated donor transplantations. At the time of GF, three patients had complete donor chimerism, five had mixed chimerism, and five had complete recipient chimerism. The median time from the first transplantation to the second transplantation was 49 (range 35–120) days. The medians of infused cell doses were as follows: mononuclear cells 7.93 (5.95–12.51) × 108/kg and CD34 + cells 2.28 (0.75–5.57) × 106/kg. All 13 patients achieved neutrophil engraftment after the second transplantation, with a median engraftment time of 11 (range 10–20) days after transplantation. The platelet engraftment rate on day 100 after transplantation was 76.9%. The TRMs at day 30, day 100, and 1-year were 0, 0, and 23.1%, respectively. The OS and disease-free survival at 1-year were 56.6 and 48.4%, respectively. For patients with GF after first transplantation, a second transplantation using a fludarabine/cyclophosphamide regimen from a different HID was a promising salvage option. Further investigation is needed to confirm the suitability of this method.

show abstract

“…The graft failure rate after salvage transplant is still high, and stable engraftment has been reported as low as 33% in the literature [ 51 , 53 ]. Nevertheless, the survival rate of patients with GF after allogeneic HSCT without a second salvage transplantation is dismal, at only < 10% [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Graft failure after allogeneic hematopoietic stem cell transplantation in pediatric patients with acute leukemia: autologous reconstitution or second transplant?

Rostami,

Mirhosseini

et al. 2024

Stem Cell Res Ther

View full text Add to dashboard Cite

Background Graft failure (GF) is a rare but serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Prevention of graft failure remains the most advisable approach as there is no clear recommendation for the best strategies for reversing this complication. Administration of growth factor, additional hematopoietic progenitor boost, or a salvage HSCT are current modalities recommended for the treatment of GF. Autologous recovery without evidence of disease relapse occurs rarely in patients with GF, and in the absence of autologous recovery, further salvage transplantation following a second conditioning regimen is a potential treatment option that offers the best chances of long-term disease-free survival. The preconditioning regimens of second HSCT have a significant impact on engraftment and outcome, however, currently there is no consensus on optimal conditioning regimen for second HSCT in patients who have developed GF. Furthermore, a second transplant from a different donor or the same donor is still a matter of debate. Observations We present our experience in managing pediatric patients with acute leukemia who encountered graft failure following stem cell transplantation. Conclusions and relevance Although a second transplantation is almost the only salvage method, we illustrate that some pediatric patients with acute leukemia who experience graft failure after an allogeneic stem cell transplant using Myeloablative conditioning (MAC) regimen may achieve long-term disease-free survival through autologous hematopoiesis recovery.

show abstract

Haploidentical transplants for patients with graft failure after the first allograft

Cited by 6 publications

References 6 publications

Salvage haploidentical or cord‐blood allogeneic stem cell transplantation after a prior alternative allograft in hematologic malignancies: A retrospective study from the SFGM‐TC

Salvage haploidentical or cord‐blood allogeneic stem cell transplantation after a prior alternative allograft in hematologic malignancies: A retrospective study from the SFGM‐TC

Graft Failure in Patients With Hematological Malignancies: A Successful Salvage With a Second Transplantation From a Different Haploidentical Donor

Graft failure after allogeneic hematopoietic stem cell transplantation in pediatric patients with acute leukemia: autologous reconstitution or second transplant?

Contact Info

Product

Resources

About