Poor graft function after haploidentical stem cell transplantation with post-transplant cyclophosphamide

Area of Science:

• Hematology
• Immunology
• Transplantation

Background:

• Haploidentical stem cell transplantation (haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) is an established treatment modality.
• Poor graft function (PGF) is a significant complication affecting patient outcomes post-transplant.
• Identifying risk factors and effective management strategies for PGF is crucial.

Purpose of the Study:

• To investigate the incidence and characteristics of PGF in adult patients undergoing haplo-SCT with PT-Cy.
• To identify potential risk factors associated with the development of PGF.
• To evaluate the effectiveness of treatment strategies for PGF.

Main Methods:

• Retrospective cohort study of 161 adult patients receiving haplo-SCT with PT-Cy.
• PGF defined by persistent neutropenia or thrombocytopenia with complete donor chimerism and absence of severe GVHD or relapse.
• Analysis of patient data including cytomegalovirus (CMV) reactivation history and treatment interventions.

Main Results:

• PGF occurred in 27.5% of patients (44/161).
• Previous and early CMV reactivation were significantly more frequent in patients with PGF.
• Most patients (93.2%) achieved adequate peripheral blood counts with supportive therapy, including thrombopoietin-receptor agonists (TRA) and CD34+ cell boosts.

Conclusions:

• PGF is a frequent complication following haplo-SCT with PT-Cy.
• Cytomegalovirus (CMV) reactivation appears to be a major contributing factor to PGF development.
• While supportive therapies are effective for most, specific interventions like TRA and CD34+ boosts can manage persistent cytopenias.