Poor graft function after T cell-depleted allogeneic hematopoietic stem cell transplant

Area of Science:

• Hematology
• Transplantation Immunology
• Oncology

Background:

• Persistent graft failure (PGF) is a critical complication after hematopoietic stem cell transplantation (HCT).
• Understanding PGF contributors is crucial for improving outcomes in HCT recipients with donor chimerism.

Purpose of the Study:

• To investigate the factors associated with PGF in HCT recipients.
• To determine the impact of PGF on overall survival (OS) and progression-free survival (PFS).

Main Methods:

• Analysis of 104 HCT recipients surviving ≥100 days without relapse or major complications.
• Defined PGF by surrogate parameters: low hemoglobin, red blood cell (RBC) transfusion dependence, low platelet count, or low absolute neutrophil count (ANC).
• All patients received T cell depletion (alemtuzumab or ATG).

Main Results:

• 52% of patients met PGF criteria.
• Significant associations found between major ABO incompatibility and low platelets (OR=4.7), acute GVHD and low hemoglobin (OR=3.7), and CMV viremia and low ANC (OR=3.0).
• Non-relapse mortality (NRM) was significantly higher in the PGF group (45.5%) compared to the adequate graft function group (16.7%).

Conclusions:

• PGF is common and associated with specific clinical factors in T cell-depleted HCT.
• PGF significantly increases NRM, highlighting the need for early identification and management.
• Further research is warranted to mitigate PGF and improve long-term HCT outcomes.