title: Second unrelated donor hematopoietic cell transplantation for primary graft failure.
abstract: Failure to engraft donor cells is a devastating complication after allogeneic hematopoietic cell transplantation (HCT). We describe the results of 122 patients reported to the National Marrow Donor Program between 1990 and 2005, who received a second unrelated donor HCT after failing to achieve an absolute neutrophil count of >or=500/microL without recurrent disease. Patients were transplanted for leukemia (n = 83), myelodysplastic disorders (n = 16), severe aplastic anemia (n = 20), and other diseases (n = 3). The median age was 29 years. Twenty-four patients received second grafts from a different unrelated donor. Among 98 patients who received a second graft from the same donor, 28 received products that were previously collected and cryopreserved for the first transplantation. One-year overall survival (OS) after second transplant was 11%, with 10 patients alive at last follow-up. We observed no differences between patients who received grafts from the same or different donors, or in those who received fresh or cryopreserved product. The outcomes after a second allogeneic HCT for primary graft failure are dismal. Identifying risk factors for primary graft failure can decrease the incidence of this complication. Further studies are needed to test whether early recognition and hastened procurement of alternative grafts can improve transplant outcomes for primary graft failure.
authors.affiliation: Banner Blood Marrow Transplant Program and City of Hope Banner, Phoenix, Arizona, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schriber
authors.forename: Manza-A
authors.initials: MA
authors.lastname: Agovi
authors.forename: Vincent
authors.initials: V
authors.lastname: Ho
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Brent
authors.initials: B
authors.lastname: Logan
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhauser
authors.forename: Roger H
authors.initials: RH
authors.lastname: Giller
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult