Second haploidentical stem cell transplantation for primary graft failure

We report the outcome of 19 patients who experienced primary graft failure (PrGF) after a haploidentical (HAPLO), unmanipulated bone marrow transplant. The median age of patients was 52 years; the conditioning regimen of the first HAPLO transplant was either full dose total body irradiation (TBI) or...

Full description

Saved in:
Bibliographic Details
Published in:Bone marrow transplantation (Basingstoke) 2021-06, Vol.56 (6), p.1291-1296
Main Authors: Giammarco, Sabrina, Raiola, Anna Maria, Di Grazia, Carmen, Bregante, Stefania, Gualandi, Francesca, Varaldo, Riccardo, Chiusolo, Patrizia, Sora, Federica, Sica, Simona, Laurenti, Luca, Metafuni, Elisabetta, Innocenti, Idanna, Autore, Francesco, Murgia, Barbara, Bacigalupo, Andrea, Angelucci, Emanuele
Format: Article
Language:English
Subjects:
Antibodies
Bone marrow
Bone marrow transplantation
Busulfan
Care and treatment
Cyclosporins
Engraftment
Fludarabine
Genetic aspects
Graft rejection
Graft-versus-host reaction
Grafting
Grafts
Granulocyte colony-stimulating factor
Irradiation
Mycophenolic acid
Organ donors
Patient outcomes
Prophylaxis
Radiation
Radiation dosage
Regression analysis
Risk factors
Stem cell transplantation
Stem cells
Transplantation
Transplants & implants
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We report the outcome of 19 patients who experienced primary graft failure (PrGF) after a haploidentical (HAPLO), unmanipulated bone marrow transplant. The median age of patients was 52 years; the conditioning regimen of the first HAPLO transplant was either full dose total body irradiation (TBI) or fludarabine, busulfan, and thiotepa (TBF); PTCY was given to all patients together with cyclosporine and mycophenolate. All 19 patients with PrGF received a second HAPLO graft, at a median interval of 42 days (34-82) after HSCT, using the Baltimore protocol and G-CSF mobilized PB from the same (n = 13) or another HAPLO family donor (n = 6). GvHD prophylaxis was again PTCY-based; 14/19 patients had trilineage recovery (74%) and 1-year survival was 66%. Engraftment at second HAPLO was seen in 7/8 patient with, and in 5/7 patients without donor-specific antibodies (DSA). In a multivariate logistic regression analysis on the original group of 503 patients, there was a trend for a reduced dose of busulfan, to increase the risk of PrGF (p = 0.1). In conclusion, patients with PrGF following a HAPLO transplant, can be rescued with a second early HAPLO transplant, using the same or a different donor.
ISSN:0268-3369
1476-5365
DOI:10.1038/s41409-020-01183-9