title: Etiology and outcome of graft failure in pediatric hematopoietic stem cell transplant recipients.
abstract: OBJECTIVE
  To determine the incidence, etiology and outcome of graft failure in pediatric allogeneic bone marrow transplant (BMT) recipients.
  
  
  METHODS
  Patients with primary or secondary graft failure were identified by database review. A retrospective chart review was performed. Etiologic factors were identified and assessed for statistical significance.
  
  
  RESULTS
  309 children underwent allogeneic BMT during the time interval studied. Four cases of primary graft failure and 7 cases of secondary graft failure occurred. Nonmalignant diagnosis, lower total nucleated cell (TNC) dose, and conditioning without total body irradiation were associated with a higher incidence of graft failure. Donor source, donor/recipient CMV status, CD34+ cell dose, and alloimmunization were not associated with graft failure.
  
  
  CONCLUSIONS
  Graft failure is a relatively uncommon occurrence in pediatric patients. Autologous reinfusion may allow time to prepare the patient for a second transplant and decrease complications associated with aplasia. More immunosuppressive conditioning regimens may decrease the incidence of graft failure, particularly in patients with non-malignant diseases or those with lower stem cell doses. More frequent monitoring of chimerism by VNTR analysis may detect late graft failure earlier and allow for more rapid intervention.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. paul.woodard@stjude.org
authors.forename: Paul
authors.initials: P
authors.lastname: Woodard
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.forename: Stacye
authors.initials: S
authors.lastname: Richardson
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: Ely
authors.initials: E
authors.lastname: Benaim
authors.forename: Terrence
authors.initials: T
authors.lastname: Geiger
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Wing
authors.initials: W
authors.lastname: Leung
authors.forename: Victoria
authors.initials: V
authors.lastname: Turner
authors.forename: Usman
authors.initials: U
authors.lastname: Yusuf
authors.forename: John
authors.initials: J
authors.lastname: Cunningham
authors.forename: Rupert
authors.initials: R
authors.lastname: Handgretinger
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology / Q000379:methods; D002648:Child; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation