title: The incidence, risk factors, and outcomes of primary poor graft function after unmanipulated haploidentical stem cell transplantation.
abstract: Primary poor graft function (PGF) is a severe complication after allogeneic stem cell transplantation (SCT). The incidence, risk factors, and outcomes of PGF have not been well described, especially in the haploidentical SCT setting. We retrospectively reviewed patients who received haploidentical SCT at Peking University Institute of Hematology between January 1, 2011, and December 31, 2012. PGF was defined as persistent neutropenia (≤0.5 × 10(9) L(-1)), thrombocytopenia (platelets ≤20 × 10(9) L(-1)), and/or hemoglobin ≤70 g L(-1) after engraftment with hypocellular bone marrow and full donor chimerism, without concurrent graft-versus-host disease or disease relapse. Incidence was calculated from all patients. Of the 464 total patients, 26 (5.6 %) developed primary PGF. The risk factors were analyzed and compared with control patients with good graft function who were selected using the case-pair method. Finally, 104 patients were selected as a control group according to the matching conditions: (1) the type (acute leukemia, myelodysplastic syndrome (MDS), chronic myelogenous leukemia (CML)) and status (standard risk, high risk) of underlying disease, (2) sex, (3) year in which the transplantation was received, and (4) a 1:4 ratio of case-control. No factors were found to be associated with primary PGF. Compared to cases with good graft function, patients with primary PGF experienced poor overall survival (34.6 vs. 82.7 %, p < 0.001). Of the 26 primary PGF patients, only nine achieved hematopoietic recovery and survived. In conclusion, primary PGF is a rare but life-threatening complication after haploidentical SCT, and effective therapies need to be explored.
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
authors.forename: Yu-Qian
authors.initials: YQ
authors.lastname: Sun
authors.forename: Gan-Lin
authors.initials: GL
authors.lastname: He
authors.forename: Ying-Jun
authors.initials: YJ
authors.lastname: Chang
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Wang
authors.forename: Jing-Zhi
authors.initials: JZ
authors.lastname: Wang
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome