[Second transplantation for 22 patients with graft failure after first allogeneic stem cell transplantation]

To improve the understanding of treatment for graft failure by analyzing the efficacy of second transplantation for graft failure after first allogeneic stem cell transplantation (allo-HSCT).

Twenty-two patients encountered graft failure after first allo-HSCT from Peking University Institute of Hematology were retrospectively reviewed. The incidence of re-engratment, graft versus host disease (GVHD) and overall survival (OS) was analyzed. Also the factors associated with re-engraftment and OS were analyzed in multivariate model.

Twenty-two patients encountered graft failure, including 12 primary graft failure and 10 secondary graft failure. 13(59.1%) patients acquired engraftment. And 13 patients acquired neutropil engraftment with median time of 15 (7-26) days, while 9 patients acquired platelet engraftment with median time of 12 (7-14) days. None of the factors included in mulivariate analysis showed impact on engraftment. The treatment related mortality at 100 day and 3 years after second transplantation was 40.9% and 72.7%, respectively. The main cause of death was infection (13/17). The 3-year OS was 22.7%, and the main cause of death was infection (13/17). The factors associated with OS included primary graft failure [P=0.001, HR 40.207 (4.828-334.868)] and receiving second transplantation in 60 days after first transplantation [P=0.003, HR 12.340 (2.290-66.498)].

Second transplantation may be an effective salvage choice for graft failure. However, the efficacy was far from satisfactory.