Etiology and outcome of graft failure in pediatric hematopoietic stem cell transplant recipients.
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.
Woodard
Paul
P
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. paul.woodard@stjude.org
Tong
Xin
X
Richardson
Stacye
S
Srivastava
Deo Kumar
DK
Horwitz
Edwin M
EM
Benaim
Ely
E
Geiger
Terrence
T
Hale
Gregory
G
Leung
Wing
W
Turner
Victoria
V
Yusuf
Usman
U
Cunningham
John
J
Handgretinger
Rupert
R
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