Work

Long-term follow up of patients who experienced graft failure post allogeneic progenitor cell transplantation

Year: 2005

Type: article

Abstract: Graft failure (GF) is life-threatening complication of allogeneic transplant (Allo-T). Long-term outcomes of interventions used to treat this complication have not been extensively studied. We retrospectively reviewed the long-term survival after GF occurring at the M.D. Anderson Cancer Center from 1990–2000. Allo-T recipients were included if they had GF for any of the following reasons 1) Primary GF (PGF) if pts failed to achieve an ANC >500/μl for 3 consecutive days by day 28 post transplant if bone marrow (BM) or peripheral blood (PBPCs) were the stem cell sourceor 42 days for cord blood (CB); 2) Primary GF with autologous reconstitution (PGF-AR) if patients recovered hematopoiesis without evidence of donor cell engraftmentor 3) Secondary GF (SGF) if there was a decrease in ANC levels to <500/μl for 3 consecutive days after having achieved engraftment without disease progression. 68 pts were identified out of a total of 1750 (4%) allografts performed during that time period. Median age was 37 yrs (range 4–75); diagnosis included 22 pts with CML or other myeloproliferative disorders, 27 with acute leukemia, 17 with lymphoma or CLL, and 2 with aplastic anemia. 31 pts received cells from a related donor (15 mismatched in at least 1 allele) while 37 received cells from an unrelated donor. 36 pts received BM29 received PB, and 3 received CB. 29 pts had PGF, 9 pts had PGF-AR and 30 pts had SGF. The 1 and 5 yr overall survival (OS) for all pts was 31% and 15%. The 1 yr and 5 yr OS for each group were: PGF-29%/18% PGF-AR 55%/11% and SGF 26%/13%. The following Table 1 shows the 1 yr and 5 yr survival rates of pts according to the intervention received. The most common causes of death were GF (18%) and engraftment but death from infection (27%) and recurrent/persistent disease (41%). We conclude that pts who experience GF post allogeneic transplantation can be successfully treated with a variety of intervention, however, death from other causes is common. Our data suggest that harvesting autologous cells for back-up in pts undergoing Allo-T procedures with high risk of GF is warranted. Tabled 1Outcomes According to Therapy for GFNoneGrowth FactorsAuto Back UpRetrans-plant Same DonorAllo Back UpRetrans-plant Different DonorN919101493OS @ 1/5 yrs33%/0%29%/17%60%/40%21%/7%8%/8%60%/33% Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2004.12.091