Incidence, Management, and Prognosis of Graft Failure and Autologous Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation.

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  • Additional Information
    • Source:
      Publisher: Korean Academy of Medical Science Country of Publication: Korea (South) NLM ID: 8703518 Publication Model: Electronic Cited Medium: Internet ISSN: 1598-6357 (Electronic) Linking ISSN: 10118934 NLM ISO Abbreviation: J Korean Med Sci Subsets: MEDLINE
    • Publication Information:
      Original Publication: Seoul, Korea : Korean Academy of Medical Science, [1986-
    • Subject Terms:
      Graft Rejection/*epidemiology ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Transplantation Conditioning/*methods ; Transplantation, Homologous/*adverse effects; Adolescent ; Adult ; Aged ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation/methods ; Humans ; Leukemia, Myeloid, Acute/therapy ; Male ; Middle Aged ; Transplantation Conditioning/adverse effects ; Treatment Failure ; Young Adult
    • Abstract:
      Background: This study presents outcomes of management in graft failure (GF) after allogeneic hematopoietic stem cell transplantation (HCT) and provides prognostic information including rare cases of autologous reconstitution (AR).
      Methods: We analyzed risk factors and outcomes of primary and secondary GF, and occurrence of AR in 1,630 HCT recipients transplanted over period of 18 years (January 2000-September 2017) at our center.
      Results: Primary and secondary GF occurred in 13 (0.80%), and 69 patients (10-year cumulative incidence, 4.5%) respectively. No peri-transplant variables predicted primary GF, whereas reduced intensity conditioning (RIC) regimen (relative risk [RR], 0.97-28.0, P < 0.001) and lower CD34⁺ cell dose (RR, 2.44-2.84, P = 0.002) were associated with higher risk of secondary GF in multivariate analysis. Primary GF demonstrated 100% mortality, in the secondary GF group, the 5-year Kaplan-Meier survival rate was 28.8%, relapse ensued in 18.8%, and AR was observed in 11.6% (n = 8). In survival analysis, diagnosis of aplastic anemia (AA), chronic myeloid leukemia and use of RIC had a positive impact. There were 8 patients who experienced AR, which was rarely reported after transplantation for acute leukemia. Patient shared common characteristics such as young age (median 25 years), use of RIC regimen, absence of profound neutropenia, and had advantageous survival rate of 100% during follow period without relapse.
      Conclusion: Primary GF exhibited high mortality rate. Secondary GF had 4.5% 10-year cumulative incidence, median onset of 3 months after HCT, and showed 5-year Kaplan-Meier survival of 28.8%. Diagnosis of severe AA and use of RIC was both associated with higher incidence and better survival rate in secondary GF group. AR occurred in 11.6% in secondary GF, exhibited excellent prognosis.
      Competing Interests: The authors have no potential conflicts of interest to disclose.
      (© 2021 The Korean Academy of Medical Sciences.)
    • References:
      Blood. 1989 Feb;73(2):606-13. (PMID: 2644980)
      Bone Marrow Transplant. 2008 Sep;42(6):397-404. (PMID: 18574445)
      Bone Marrow Transplant. 2013 Apr;48(4):537-43. (PMID: 23222384)
      Bone Marrow Transplant. 2020 Jun;55(6):1023-1028. (PMID: 31819152)
      Bone Marrow Transplant. 2010 Jun;45(6):1008-13. (PMID: 19915627)
      Bone Marrow Transplant. 2017 Sep;52(9):1241-1248. (PMID: 28319073)
      J Hematol Oncol. 2016 Aug 03;9(1):65. (PMID: 27488518)
      N Engl J Med. 1989 Jan 26;320(4):197-204. (PMID: 2643045)
      Br J Cancer. 2003 Aug 4;89(3):431-6. (PMID: 12888808)
      Biol Blood Marrow Transplant. 2010 Aug;16(8):1099-106. (PMID: 20172038)
      Bone Marrow Transplant. 2005 Oct;36(8):683-9. (PMID: 16113673)
      Biol Blood Marrow Transplant. 2007 Jun;13(6):675-82. (PMID: 17531777)
      Bone Marrow Transplant. 2016 May;51(5):687-91. (PMID: 26855158)
      Bone Marrow Transplant. 2020 Sep;55(9):1784-1795. (PMID: 32051535)
      N Engl J Med. 1977 Jan 13;296(2):61-6. (PMID: 136605)
      N Engl J Med. 1985 Sep 26;313(13):765-71. (PMID: 3897863)
      Bone Marrow Transplant. 2000 Dec;26(11):1173-7. (PMID: 11149727)
      Best Pract Res Clin Haematol. 2007 Jun;20(2):155-70. (PMID: 17448954)
      Leukemia. 2015 Aug;29(8):1754-62. (PMID: 25772027)
      Bone Marrow Transplant. 2007 Aug;40(4):381-7. (PMID: 17563735)
      Biol Blood Marrow Transplant. 2008 Aug;14(8):859-66. (PMID: 18640568)
      Bone Marrow Transplant. 2016 Sep;51(9):1223-7. (PMID: 27088376)
    • Contributed Indexing:
      Keywords: Autologous Reconstitution; Primary Graft Failure; Reduced-intensity Conditioning; Secondary Graft Failure
    • Publication Date:
      Date Created: 20210615 Date Completed: 20211105 Latest Revision: 20211105
    • Publication Date:
      20221213
    • Accession Number:
      PMC8203852
    • Accession Number:
      10.3346/jkms.2021.36.e151
    • Accession Number:
      34128593