title: Successful early unmanipulated haploidentical transplantation with reduced-intensity conditioning for primary graft failure after cord blood transplantation in hematologic malignancy patients.
abstract: Primary graft failure (pGF) is a frequent complication following cord blood transplantation (CBT). For those patients who will not experience autologous recovery, salvage transplantation should be performed as early as possible. However, standardized treatment protocols for pGF, such as the optimal stem cell source, preparative regimen and the ideal time for salvage transplantation, have yet to be determined. Therefore, we analyzed 17 hematologic malignancy patients who received unmanipulated haploidentical peripheral blood (PB) and BM transplantation with reduced-intensity conditioning (RIC) as a salvage therapy for pGF after CBT. The median interval between the two transplantations was 38 days. The RIC regimen for salvage transplantation consisted of fludarabine, antithymocyte globulin, CY and low-dose TBI. The neutrophil and plt engraftments were achieved in 14 (82.4%) and 13 (76.4%) patients, respectively. The cumulative incidences of grades II-IV and grades III-IV aGVHD were 35.3% and 17.6%, respectively. The cumulative incidence of chronic GVHD was 29.4%. After a median follow-up of 43 months, 10 of 17 patients remained alive in CR. The cumulative incidence of TRM at 180 days was 29.4%. The probability of 3-year OS and leukemia-free survival was 57.5%. Our results show that unmanipulated haploidentical PB and BM transplantation under a RIC regimen is an effective treatment for pGF after CBT.
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: B L
authors.initials: BL
authors.lastname: Tang
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: X Y
authors.initials: XY
authors.lastname: Zhu
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: C C
authors.initials: CC
authors.lastname: Zheng
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: H L
authors.initials: HL
authors.lastname: Liu
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: L Q
authors.initials: LQ
authors.lastname: Geng
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: X B
authors.initials: XB
authors.lastname: Wang
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: K Y
authors.initials: KY
authors.lastname: Ding
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: W
authors.initials: W
authors.lastname: Yao
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: J
authors.initials: J
authors.lastname: Tong
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: K D
authors.initials: KD
authors.lastname: Song
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: P
authors.initials: P
authors.lastname: Qiang
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality / Q000628:therapy*; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*
chemical_list: D019653:Myeloablative Agonists