Salvage haploidentical transplantation for graft failure using reduced-intensity conditioning
S Yoshihara1, K Ikegame, K Taniguchi
1Department of Internal Medicine, Division of Hematology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan. yoshihar@hyo-med.ac.jp
Insights
Salvage haploidentical stem cell transplantation (haplo-SCT) is effective after graft failure from cord blood transplantation (CBT) or prior haplo-SCT. This approach offers a high survival rate, suggesting it may be preferable to CBT for salvage therapy.
Area of Science:
- Hematology
- Transplantation immunology
Background:
- Graft failure is a significant complication following cord blood transplantation (CBT) and HLA-haploidentical stem cell transplantation (haplo-SCT).
- Patients experiencing graft failure often lack alternative donor options, limiting salvage treatment choices to repeat CBT or haplo-SCT.
Purpose of the Study:
- To evaluate the efficacy and outcomes of haplo-SCT as a salvage therapy for patients with graft failure after initial CBT or haplo-SCT.
- To compare the effectiveness of haplo-SCT versus CBT in the context of salvage transplantation.
Main Methods:
- Retrospective analysis of eight patients who underwent haplo-SCT for graft failure.
- Patients received a reduced-intensity conditioning regimen including fludarabine, thiotepa, rabbit antithymocyte globulin, and low-dose total body irradiation (TBI).
Main Results:
- All eight patients achieved successful neutrophil engraftment, with a median recovery time of 10 days.
- Seven patients achieved platelet recovery, with a median time of 20 days.
- Five patients survived at a median follow-up of 946 days, with a 5-year overall survival probability of 75%.
Conclusions:
- Haplo-SCT demonstrates significant efficacy as a salvage therapy for graft failure, achieving high engraftment and survival rates.
- The findings support considering haplo-SCT over CBT as a preferred salvage stem cell transplantation strategy after primary graft failure.
Abstract:
Graft failure is a major concern after cord blood transplantation (CBT) or HLA-haploidentical transplantation (haplo-SCT). As patients who undergo CBT or haplo-SCT almost always lack both matched-related and -unrelated donors, salvage transplantation would also be limited to either CBT or haplo-SCT. In this study, we assessed eight patients who received haplo-SCT as salvage therapy for graft failure. Five and three patients had received haplo-SCT and CBT, respectively, which resulted in graft failure. The median interval from the failed transplantation to salvage transplantation in six patients with primary graft failure was 33.5 days. The reduced-intensity conditioning regimen consisted of fludarabine, thiotepa, rabbit antithymocyte globulin and low-dose TBI. All eight patients achieved neutrophil engraftment, and seven patients achieved platelet recovery. The median times to neutrophil recovery and platelet recovery were 10 and 20 days, respectively. Three patients died from treatment-related causes: two from GVHD and one from rupture of carotid artery aneurysm. Five patients are alive, at a median follow-up of 946 days. The probability of overall survival at 5 years was 75%. These findings may serve as a rationale for giving precedence to haplo-SCT over CBT in salvage SCT after graft failure.
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...