Primary graft failure following allogeneic hematopoietic stem cell transplantation: risk factors, treatment and outcomes

Chen, Juan; Pang, Aiming; Zhao, Yuanqi; Liu, Li; Ma, Runzhi; Wei, Jialin; Chen, Xin; He, Yi; Yang, Donglin; Zhang, Rongli; Zhai, Weihua; Ma, Qingyan; Jiang, Erlie; Han, Mingzhe; Zhou, Jiaxi; Feng, Sizhou

doi:10.1080/16078454.2022.2042064

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…Due to these limitations, only univariate analysis was performed. Usage of PBSC as a graft source proved to be the only factor, supported with a number of previous reports which showed statistically significant association with better engraftment and overall survival [28,29].…”

Section: Discussionsupporting

confidence: 79%

Salvage second allogeneic stem cell transplantation for primary and secondary graft failure in adult patients

Rudakova,

Yakimenko,

Volkov

et al. 2023

CTT

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We have evaluated clinical outcomes in 49 patients who received unmanipulated allogeneic hematopoietic stem cell transplantation (allo-HSCT) as a salvage treatment for primary (PGF) and secondary graft failure (SGF). The median age of patients was 31 years. Indications for the first allo-HSCT were malignant (n=43, 88%) and nonmalignant diseases (n=6, 12%). Thirteen patients with malignant diseases (27%) were in the active phase of disease. Patients with PGF received a second graft, at a median interval of 43 days (34-82) after allo-HSCT. The second allo-HSCT (HSCT2) were performed from haploidentical (n=42, 86%), HLA-matched related (n=2, 4%) and unrelated (n=5, 10%) donors. Donor-specific antibodies (DSA) before the 1 st allo-HSCT (HSCT1) were examined in 21 cases, and detected in 7 patients. Donor change in 2 nd HSCT was performed in 23 cases. Following HSCT2, the neutrophil counts exceeding 0.5×10 9 /L were achieved in 21(43%) patients with a cumulative incidence (CI) of 33% (95% CI, 19-48) and median engraftment time of 29 (1-41) days; blood platelet counts over 50×10 9 /L were achieved in 11(22%) patients. The 3 rd allo-HSCT was required in 14 patients. A total of 34 patients died, the cause of death in 31 cases was infection, in three cases -relapse of the underlying disease. The one-year relapse-free survival rate after HSCT2 was 65% (95% CI 51-79), the one-year event-free survival rate) was 20% (95%CI, 11-37) with relapce, acute graft-versus-host disease (aGvHD) grade 3-4 considered as event.One-year overall survival (OS) was 33% (95% CI, 22-50), 5 year OS was 28% (95% CI, 18-45). Source of the graft was the only factor which showed an association with OS: usage of peripheral blood stem cells (50%; 95%, CI 31-66) versus bone marrow (26%; 95% CI 2-65, p=0.049).

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Section: Discussionsupporting

confidence: 79%

Salvage second allogeneic stem cell transplantation for primary and secondary graft failure in adult patients

Rudakova,

Yakimenko,

Volkov

et al. 2023

CTT

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“…3 ). Seven studies [ 21 , 22 , 24 , 25 , 31 , 32 , 35 ] support that CMV reactivation increases the risk of poor graft function, while two studies [ 16 , 19 ] showed no association between CMV reactivation and poor graft function (Table 4 , Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

The indirect effects of CMV reactivation on patients following allogeneic hematopoietic stem cell transplantation: an evidence mapping

Wu,

Ma,

Song

et al. 2024

Ann Hematol

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Cytomegalovirus (CMV) reactivation following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a challenging problem, and the impact on the risk of overall mortality (OM) and non-relapse mortality (NRM) in patients following allo-HSCT is still controversial. Utilizing the evidence mapping method, we aimed to assess the effect of CMV infection on outcomes of patients post-transplantation and identify research gaps through systematic reviews (SRs) and clinical studies. PubMed, EMBASE, Web of Science, and Cochrane library databases were searched from inception until 5 July 2022 to identify relevant literature. After systematic literature screening and data extraction, evidence mapping of the effects of CMV reactivation on patients post-allo-HSCT was conducted. Three SRs and 22 clinical studies were included. In one SR, CMV reactivation was associated with an increased risk of mortality (HR 1.46; 95% CI, 1.24–1.72; P ≤ 0.001). In two SRs, CMV reactivation was associated with NRM. One SR reported CMV reactivation was potentially associated with significant protection against relapse in patients with acute myelocytic leukemia (AML), but no significant correlation with graft-versus-host disease (GVHD) was found. Lastly, in one SR CMV reactivation significantly increased the risk of invasive fungal disease (IFD). Most clinical articles reported that CMV reactivation increased the risk of renal dysfunction, poor graft function, re-hospitalization, and bacterial infections. CMV reactivation following allo-HSCT is associated with an increased risk of OM, NRM, IFD, and renal dysfunction, as well as a reduced risk of relapse in patients with AML.

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“…GF was more often after haploidentical transplantation (haplo-SCT) [11,12], ranged from 1-10% according to different transplantation modalities [13][14][15]. Management of GF after haploidentical transplantation is di cult.…”

Section: Introductionmentioning

confidence: 99%

Salvage haploidentical transplantation for graft failure after first haploidentical allogeneic stem cell transplantation: an updated experience

Ma,

Zhu,

Zhang

et al. 2024

Bone Marrow Transplant

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Second transplantation was almost the only salvage for graft failure. However, there is no recommended regimens for second transplantation, especially in the haplo-SCT setting. We recently reported very encouraging outcomes using a novel method (salvage haploidentical transplantation from a different donor after conditioning with udarabine 30mg/m 2 from − 6d to -2d and cyclophosphamide 1g/m 2 from − 5d to -4d). Herein, we reported our updated experience in a total of 30 patients using this method. The median time of the second transplantation was 96.5 (33-215) days after the rst transplantation. Among the 30 patients, 2 used the same donor since there was no other donor available. One patient died before engraftment at 19 days after second transplantation. For the 29 evaluable patients, neutrophil engraftments were achieved in all (100%) patients at a median of 11 (8-24) days, while platelet engraftments were achieved in 22 (75.8%) patients at a median of 17.5 (9-140) days. The 1-year OS and DFS was 60% and 53.3%, respectively. CIR and TRM was 6.7% and 33.3%, respectively. Compared with historical group (n = 34), the neutrophil engraftment (100% versus 58.5%, p < 0.001) and platelet engraftment (75.8% versus 32.3%, p < 0.001) were signi cantly better in the novel regimen group, and the OS was also signi cantly improved (60.0% versus 26.4%, p = 0.011). In conclusion, salvage haploidentical transplantation from a different donor using Flu/Cy regimen represents a promising option to rescue patients with graft failure after the rst haploidentical stem cell transplantation.

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Primary graft failure following allogeneic hematopoietic stem cell transplantation: risk factors, treatment and outcomes

Cited by 7 publications

References 28 publications

Salvage second allogeneic stem cell transplantation for primary and secondary graft failure in adult patients

Salvage second allogeneic stem cell transplantation for primary and secondary graft failure in adult patients

The indirect effects of CMV reactivation on patients following allogeneic hematopoietic stem cell transplantation: an evidence mapping

Salvage haploidentical transplantation for graft failure after first haploidentical allogeneic stem cell transplantation: an updated experience

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