[Second transplantation for graft failure after allogeneic hematopoietic stem cell transplantation--a retrospective survey by Kanto Study Group for Cell Therapy].
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.
Hagihara
Maki
M
Department of Hematology, Kanagawa Cancer Center.
Kanamori
Heiwa
H
Sakai
Miwa
M
Mori
Takehiko
T
Nakaseko
Chiaki
C
Aotsuka
Nobuyuki
N
Uehara
Taeko
T
Sakura
Tohru
T
Yoshiba
Fumio
F
Kawai
Nobutaka
N
Tanaka
Masatsugu
M
Fujisawa
Shin
S
Ohwada
Chikako
C
Wakita
Hisashi
H
Yokota
Akira
A
Kawamura
Toshihide
T
Maruta
Atsuo
A
Sakamaki
Hisashi
H
Okamoto
Shinichiro
S
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
D007166:Immunosuppressive Agents; D016559:Tacrolimus