0
selected
-
1.
Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
Nagler, A., Labopin, M., Swoboda, R., Kulagin, A., Velardi, A., Sanz, J., Labussière-Wallet, H., Potter, V., Kuball, J., Sica, S., et al
Bone marrow transplantation. 2023
Abstract
Second transplantation (HSCT2) is a potential treatment for primary graft failure (pGF). We assessed the outcome of HSCT2, performed between 2000 and 2021, for pGF in 243 patients with acute leukemia. Median age was 44.8 years. Conditioning at first HSCT (HSCT1) was myeloablative (MAC) in 58.4%. Median time from HSCT1 to HSCT2 was 48 days. Donors for HSCT2 were the same as for HSCT1 in 49%. Engraftment post HSCT2 was achieved by 73.7% of patients. The incidence of acute (a) graft versus host disease (GVHD) grades II-IV and III-IV was 23.2 and 8.1%. 5-year total and extensive chronic (c) GVHD was 22.3 and 10.1%. 5-year nonrelapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD free, relapse-free survival (GRFS) was 51.6, 18.8, 29.6, 30.7 and 22.4%, respectively. Infections were the main cause of death. In multivariable analysis, being transplanted at second vs. first remission, lower Karnofsky performance status (KPS; <90) and receiving MAC at HSCT1 were adverse prognostic factors for NRM, LFS, OS, and GRFS, as was increased age for NRM, LFS, OS. We conclude that HSCT2 can rescue about a third of the patients who experienced pGF, but NRM is as high as 50%.
-
2.
Outcomes of graft failure after umbilical cord blood transplantation in acute leukemia: a study from Eurocord and the Acute Leukemia Working Party of the EBMT
Baron, F., Ruggeri, A., Peczynski, C., Labopin, M., Bourhis, J. H., Michallet, M., Chevallier, P., Sanz, J., Forcade, E., Saccardi, R., et al
Bone marrow transplantation. 2023
Abstract
Graft failure has remained a limitation of umbilical cord blood transplantation (CBT). Here, we assessed the outcomes of patients who experienced graft failure after CBT. Inclusion criteria were patients (age ≥ 18 years) experiencing graft failure after unrelated CBT (single or double) between 2005 and 2016, for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL), no prior allogeneic or autologous transplantation, no other stem cell product. The study included 87 patients. At 1-year, cumulative incidence of relapse and nonrelapse mortality (NRM) was 35% and 37%, respectively. One-year overall survival (OS) and progression-free survival (PFS) was 40% and 29%, respectively. Forty-six patients underwent a salvage second transplantation with 1-year and 2-year OS and PFS from second transplantation 41% and 34% for OS, and 37% and 34% for PFS, respectively. In multivariate analysis, complete remission (CR) at CBT (HR = 0.45, 95% CI 0.25-0.83, P = 0.01) and reduced-intensity conditioning (HR = 0.51, 95% CI 0.29-0.91, P = 0.023) were associated with better OS. In conclusion, in this retrospective study, we observed that approximately one-quarter of patients experiencing graft failure after CBT remained alive without relapse 2 years later.
-
3.
Outcomes of Salvage Haploidentical Transplant with Post-transplant Cyclophosphamide for Rescuing Graft Failure Patients: a Report on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy
Prata, P. H., Resche-Rigon, M., Blaise, D., Socie, G., Rohrlich, P. S., Milpied, N., Turlure, P., Nguyen, S., Sirvent, A., Bulabois, C. E., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
-
-
-
Free full text
-
Editor's Choice
Abstract
Prognosis of patients with graft failure is dismal, and re-transplantation is the sole option for long-term survival. To address the interest of haploidentical transplantation as a salvage option in this context, we analyzed data from 24 patients with graft failure or loss re-transplanted with a haploidentical donor who received post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease prophylaxis (GvHD). Fludarabine-based reduced intensity conditioning was used in 23 patients, and 14 patients received the Baltimore regimen. The median delay between previous and salvage transplantation for graft failure was 63 (39-98) days. Besides PT-Cy, all patients received cyclosporine, and 22 patients also received MMF for GvHD prophylaxis. With a median follow up of 353 (16-2010) days, 1-year OS was 56% (95% CI: 38 - 81). Transplant complications accounted for 80% of deaths. The cumulative incidence of neutrophil engraftment was +30 was 79%. Cumulative incidence of grade II-IV acute GvHD at day-100 was 14%, and 1-year CI of chronic GvHD was 31%. One-year CI of relapse was 13%. Stem cell source did not impact on engraftment, GvHD, relapse nor overall survival. Salvage haploidentical transplant with PT-Cy for rescuing graft failure patients leads to an acceptable 1-year OS and might be a valid option in this poor situation.
PICO Summary
Population
Patients with graft failure or loss (n=24)
Intervention
Re-transplantation with a haploidentical donor who received post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease prophylaxis.
Comparison
None
Outcome
With a median follow up of 353 days, 1-year OS was 56%. Transplant complications accounted for 80% of deaths. The cumulative incidence of neutrophil engraftment was +30 was 79%. Cumulative incidence of grade II-IV acute GvHD at day-100 was 14%, and 1-year CI of chronic GvHD was 31%. One-year CI of relapse was 13%. Stem cell source did not impact on engraftment, GvHD, relapse nor overall survival.
-
4.
The European Society for Blood and Marrow Transplantation (EBMT) Consensus Guidelines for the Detection and Treatment of Donor-specific Anti-HLA Antibodies (DSA) in Haploidentical Hematopoietic Cell Transplantation
Ciurea, S. O., Cao, K., Fernandez-Vina, M., Kongtim, P., Malki, M. A., Fuchs, E., Luznik, L., Huang, X. J., Ciceri, F., Locatelli, F., et al
Bone Marrow Transplantation. 2018;53(5):521-534
-
-
-
Free full text
-
Full text
Abstract
Haploidentical donors are now increasingly considered for transplantation in the absence of HLA-matched donors or when an urgent transplant is needed. Donor-specific anti-HLA antibodies (DSA) have been recently recognized as an important barrier against successful engraftment of donor cells, which can affect transplant survival. DSA appear more prevalent in this type of transplant due to higher likelihood of alloimmunization of multiparous females against offspring's HLA antigens, and the degree of mismatch. Here we summarize the evidence for the role of DSA in the development of primary graft failure in haploidentical transplantation and provide consensus recommendations from the European Society for Blood and Marrow Transplant Group on testing, monitoring, and treatment of patients with DSA receiving haploidentical hematopoietic progenitor cell transplantation.
Clinical Commentary
What is known?
NIHMS1586888
What did this paper set out to examine?
What did they show?
What are the implications for practice and for future work?