Graft failure after allogeneic hematopoietic cell transplantation.
Graft failure is a significant complication following allogeneic hematopoietic cell transplantation (alloHCT). It may result from rejection caused by recipient T cells, natural killer (NK) cells, or antibodies. It is increased in HLA-mismatched grafts, unrelated grafts, T cell-replete transplants, sensitized patients, and in patients treated with reduced-intensity conditioning (RIC). In recipients of unrelated grafts, graft failure is increased in patients receiving major AB0 blood group mismatched transplants (P = .008). Recent data also suggest that donor-specific antibodies to CD34(+)/VEGFR-2(+) cells may be involved in graft failure after alloHCT. Graft failure may be overcome by more intensified conditioning, increased cell dose, or more effective immunosuppression. With more frequent use of RIC, cord blood grafts and other HLA-mismatched transplants, graft failure is an increasing problem after alloHCT.
Mattsson
Jonas
J
Center for Allogeneic Stem Cell Transplantation, Division of Clinical Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Ringdén
Olle
O
Storb
Rainer
R
D036101:Cord Blood Stem Cell Transplantation; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D012307:Risk Factors; D014184:Transplantation, Homologous