title: Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI.
abstract: Graft failure remains a severe complication of hematopoietic stem cell transplantation (HSCT). Several risk factors have already been published. In this study, we re-evaluated them in a large cohort who had the benefit of the recent experience in HSCT (2006-2012). Data from 4684 unrelated donor HSCT from 2006 to 2012 were retrospectively collected from centers belonging to the French Society for Stem Cell Transplantation. Among the 2716 patients for whom HLA typing was available, 103 did not engraft leading to a low rate of no engraftment at 3.8%. In univariate analysis, only type of disease and status of disease at transplant for malignant diseases remained significant risk factors (P=0.04 and P<0.0001, respectively). In multivariate analysis, only status of disease was a significant risk factor (P<0.0001). Among the 61 patients who did not engraft and who were mismatched for 1 HLA class I and/or HLA-DP, 5 donor-specific antibodies (DSAs) were detected but only 1 was clearly involved in graft failure, for the others their role was more questionable. Second HSCT exhibited a protective although not statistically significant effect on OS (hazard ratio=0.57 [0.32-1.02]). In conclusion, only one parameter (disease status before graft) remains risk factor for graft failure in this recent cohort.
authors: Service d'hématologie adulte, Hôpital Saint-Louis, APHP, Paris, France.|Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Nice, France.
authors: T
authors: T
authors: Cluzeau
authors: Hôpital Saint-Louis, Service de Biostatistique et Information Médicale, APHP, Paris, France.
authors: J
authors: J
authors: Lambert
authors: Data Management of SFGM-TC, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
authors: N
authors: N
authors: Raus
authors: Hôpital Saint-Louis, Service de Biostatistique et Information Médicale, APHP, Paris, France.
authors: K
authors: K
authors: Dessaux
authors: Laboratory of Histocompatibility, EFS Saint Etienne, Saint Etienne, France.
authors: L
authors: L
authors: Absi
authors: Laboratory of Histocompatibility, EFS Henri Mondor, Créteil, France.
authors: F
authors: F
authors: Delbos
authors: Laboratory of Histocompatibility, EFS Pays de la Loire, Nantes, France.
authors: A
authors: A
authors: Devys
authors: Laboratory of Immunology, CHU Nice, Nice, France.
authors: M
authors: M
authors: De Matteis
authors: Laboratory of Histocompatibility, EFS Rhone Alpes, Lyon, France.
authors: V
authors: V
authors: Dubois
authors: Laboratory of Immunology, CHU Limoges, France.
authors: M
authors: M
authors: Filloux
authors: Laboratory of Immunology, CHU Toulouse, Toulouse, France.
authors: M
authors: M
authors: Fort
authors: Laboratory of Histocompatibility, EFS Normandie, Rouen, France.
authors: F
authors: F
authors: Hau
authors: Laboratory of Histocompatibility, EFS CA, Poitiers, France.
authors: I
authors: I
authors: Jollet
authors: Laboratory of Immunology, CHU Lille, Lille, France.
authors: M
authors: M
authors: Labalette
authors: Laboratory of Histocompatibility, EFS Rhône Alpes, Grenoble, France.
authors: D
authors: D
authors: Masson
authors: Laboratory of Histocompatibility, CHU Brest, France.
authors: B
authors: B
authors: Mercier
authors: Laboratory of Immunology, Hôpital Robert Debré, APHP, Paris, France.
authors: B
authors: B
authors: Pedron
authors: Laboratory of Histocompatibility, CHU Nancy, Nancy, France.
authors: P
authors: P
authors: Perrier
authors: Laboratory of Histocompatibility, EFS Alpes Mediterrannée, Marseille, France.
authors: C
authors: C
authors: Picard
authors: Laboratory of Histocompatibility, EFS Clermont-Ferrand, Clermont-Ferrand, France.
authors: F
authors: F
authors: Quainon
authors: Laboratory of Immunology, Hôpital Saint-Eloi, Montpellier, France.
authors: A
authors: A
authors: Ramounau-Pigot
authors: Laboratory of Histocompatibility, EFS Rennes, France.
authors: V
authors: V
authors: Renac
authors: Laboratory of Immunology, CHU Necker-Enfants Malades, Paris, France.
authors: P
authors: P
authors: Van Endert
authors: Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP, Labex Transplantex, Paris, France.
authors: D
authors: D
authors: Charron
authors: Service d'hématologie greffe, Hôpital Saint-Louis, APHP, Paris, France.
authors: R
authors: R
authors: Peffault de la Tour
authors: Laboratory of Immunology and Immunogenetics, CNRS UMR 5164, CHU Bordeaux, France.
authors: J L
authors: JL
authors: Taupin
authors: Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP, Labex Transplantex, Paris, France.|INSERM U1160, Hôpital Saint-Louis, Paris, France.
authors: P
authors: P
authors: Loiseau
mesh_terms: D000328:Adult; D006084:Graft Rejection / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014181:Transplantation Immunology; D016896:Treatment Outcome; D061349:Unrelated Donors