title: Graft failure in the modern era of allogeneic hematopoietic SCT.
abstract: Graft failure may contribute to increased morbidity and mortality after allogeneic hematopoietic SCT (allo-HSCT). Here, we present risk factors for graft failure in all first allo-HSCTs performed at our center from 1995 to mid-2010 (n=967). Graft failure was defined as >95% recipient cells any time after engraftment with no signs of relapse, or re-transplantation because of primary or secondary neutropenia (<0.5 × 10(9)/L) and/or thrombocytopenia (<30 × 10(9)/L). Fifty-four patients (5.6%) experienced graft failure. The majority were because of autologous reconstitution (n=43), and only a few patients underwent re-transplantation because of primary (n=6) or secondary (n=5) graft failures. In non-malignant disorders, graft failure had no effect on survival, whereas in malignant disease graft failure was associated with reduced 5-year survival (22 vs 53%, P<0.01). In multivariate analysis, ex vivo T-cell depletion (relative risk (RR) 8.82, P<0.001), HLA-mismatched grafts (RR 7.64, P<0.001), non-malignant disorders (RR 3.32, P<0.01) and reduced-intensity conditioning (RR 2.58, P<0.01) increased the risk for graft failure, whereas graft failures were prevented by total nucleated cell doses of ≥ 2.5 × 10(8)/kg (RR 0.36, P<0.01). In conclusion, graft failure was only associated with inferior survival in malignant disease. Non-malignant disorders, HLA match, conditioning intensity, immunosuppression regimen and cell dose all influenced graft failure risk.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden. Richard.Olsson@karolinska.se
authors.forename: R
authors.initials: R
authors.lastname: Olsson
authors.forename: M
authors.initials: M
authors.lastname: Remberger
authors.forename: M
authors.initials: M
authors.lastname: Schaffer
authors.forename: D M
authors.initials: DM
authors.lastname: Berggren
authors.forename: B-M
authors.initials: BM
authors.lastname: Svahn
authors.forename: J
authors.initials: J
authors.lastname: Mattsson
authors.forename: O
authors.initials: O
authors.lastname: Ringden
mesh_terms: D017074:Common Variable Immunodeficiency / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation; D008659:Metabolic Diseases / Q000401:mortality / Q000628:therapy; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D009503:Neutropenia / Q000209:etiology / Q000401:mortality; D055728:Primary Myelofibrosis / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D013921:Thrombocytopenia / Q000209:etiology / Q000401:mortality; D014184:Transplantation, Homologous