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Second haploidentical stem cell transplantation for primary graft failure.

Authors :
Giammarco S
Raiola AM
Di Grazia C
Bregante S
Gualandi F
Varaldo R
Chiusolo P
Sora F
Sica S
Laurenti L
Metafuni E
Innocenti I
Autore F
Murgia B
Bacigalupo A
Angelucci E
Source :
Bone marrow transplantation [Bone Marrow Transplant] 2021 Jun; Vol. 56 (6), pp. 1291-1296. Date of Electronic Publication: 2020 Dec 16.
Publication Year :
2021

Abstract

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.

Details

Language :
English
ISSN :
1476-5365
Volume :
56
Issue :
6
Database :
MEDLINE
Journal :
Bone marrow transplantation
Publication Type :
Academic Journal
Accession number :
33328569
Full Text :
https://doi.org/10.1038/s41409-020-01183-9