Second haploidentical stem cell transplantation for primary graft failure

Patrizia Chiusolo, Luca Laurenti, Elisabetta Metafuni, Idanna Innocenti, Francesco Autore, Andrea Bacigalupo, Anna Maria Raiola, Carmen Di Grazia, Stefania Bregante, Francesca Gualandi, Riccardo Varaldo, Barbara Murgia, Emanuele Angelucci

Risultato della ricerca: Contributo in rivistaArticolo in rivista

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.
Lingua originaleEnglish
pagine (da-a)1291-1296
Numero di pagine6
RivistaBone Marrow Transplantation
Volume56
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • Busulfan
  • Cyclophosphamide
  • Graft vs Host Disease
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Middle Aged
  • Thiotepa
  • Transplantation Conditioning

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