TY - JOUR
T1 - Second haploidentical stem cell transplantation for primary graft failure
AU - Giammarco, Sabrina
AU - Raiola, Anna Maria
AU - Di Grazia, Carmen
AU - Bregante, Stefania
AU - Gualandi, Francesca
AU - Varaldo, Riccardo
AU - Chiusolo, Patrizia
AU - Sora', Federica
AU - Sica, Simona
AU - Laurenti, Luca
AU - Metafuni, Elisabetta
AU - Innocenti, Idanna
AU - Autore, Francesco
AU - Murgia, Barbara
AU - Bacigalupo, Andrea
AU - Angelucci, Emanuele
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Busulfan
KW - Cyclophosphamide
KW - Graft vs Host Disease
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Middle Aged
KW - Thiotepa
KW - Transplantation Conditioning
KW - Busulfan
KW - Cyclophosphamide
KW - Graft vs Host Disease
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Middle Aged
KW - Thiotepa
KW - Transplantation Conditioning
UR - http://hdl.handle.net/10807/184337
U2 - 10.1038/s41409-020-01183-9
DO - 10.1038/s41409-020-01183-9
M3 - Article
SN - 0268-3369
VL - 56
SP - 1291
EP - 1296
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
ER -