title: [Second transplantation for graft failure after allogeneic hematopoietic stem cell transplantation--a retrospective survey by Kanto Study Group for Cell Therapy].
abstract: We retrospectively surveyed patients who received a second transplantation for graft failure (GF) after allogeneic hematopoietic stem cell transplantation (SCT) in hospitals participating in the Kanto Study Group for Cell Therapy. A second SCT was performed in 21 of 45 patients with primary GF and in 13 of 15 with secondary GF. The median time between the first and second SCT was 49 days (range, 18-1204 days). The diagnosis included 28 patients with hematologic malignancies and 6 with aplastic anemia. Non-myeloablative or reduced-intensity conditioning was performed in 30 patients. Cord blood was frequently used as the source of stem cells followed by related donor peripheral blood, and unrelated bone marrow. Engraftment was achieved in 23 patients (68%). Conditioning regimen including total body or total lymphoid irradiation, was significantly associated with a higher engraftment rate. Overall survival at 5 years in all patients who underwent second SCT was 34%. Prognostic factors for better survival after second SCT were a time to second SCT longer than 90 days, the performance status at second SCT with 0 or 1, and the administration of tacrolimus for GVHD prophylaxis. The major cause of death after second SCT was infection. Although the outcome of a second SCT for graft failure remains poor, these findings suggest that the selection of patients as well as transplant methods, such as conditioning and GVHD prophylaxis, may contribute to survival.
authors.affiliation: Department of Hematology, Kanagawa Cancer Center.
authors.forename: Maki
authors.initials: M
authors.lastname: Hagihara
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Miwa
authors.initials: M
authors.lastname: Sakai
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Aotsuka
authors.forename: Taeko
authors.initials: T
authors.lastname: Uehara
authors.forename: Tohru
authors.initials: T
authors.lastname: Sakura
authors.forename: Fumio
authors.initials: F
authors.lastname: Yoshiba
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kawai
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Chikako
authors.initials: C
authors.lastname: Ohwada
authors.forename: Hisashi
authors.initials: H
authors.lastname: Wakita
authors.forename: Akira
authors.initials: A
authors.lastname: Yokota
authors.forename: Toshihide
authors.initials: T
authors.lastname: Kawamura
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maruta
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007564:Japan; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus