Outcome of graft failure after allogeneic stem cell transplant: study of 89 patients

Abstract

Strategies for reversing graft failure (GF) after allogeneic stem cell transplant (SCT) depend on the options available in each situation. GF was reported in 16 Spanish institutions from January 2006 to July 2011. Primary GF was defined as an absolute neutrophil count (ANC) > 0.5 × 10⁹/L not reached by day + 28 after SCT from peripheral blood (PB) or bone marrow (BM) progenitors and by day + 42 after SCT from unrelated cord blood (UCB) progenitors. Secondary GF was defined as a recurrent ANC < 0.5 × 10⁹/L. Eighty-nine patients with GF were reported, and 80 patients received a second SCT. The 5-year survival probability was 31% (95% confidence interval [CI]: 18–44%), and the incidences of non-relapse mortality and relapse estimated by competing risks were 47% (95% CI: 36–58%) and 21% (95% CI: 4–28%). The strategy adopted to treat GF was heterogeneous, and no approach could be unequivocally recommended for this situation. The prognosis of patients with GF was poor even after successful recovery from GF.

Keywords::

• Graft failure
• hematopoietic stem cell transplant
• outcome
• infectious complications

Acknowledgments

We thank the physicians, nurses and other support staff who cared for the patients during the transplant procedures, and the clinical investigation teams at each participating institution who provided data collection and follow-up. The following transplant centers contributed to this study: Hospital La Fe (Valencia), Hospital Niño Jesús (Madrid), Hospital Universitari Germans Trias i Pujol (Badalona), Hospital Gregorio Marañón (Madrid), Hospital Puerta de Hierro (Madrid), Hospital Universitario de Salamanca, Hospital Son Espases (Palma de Mallorca), Hospital Sant Pau (Barcelona), Hospital Clínic (Barcelona), Hospital Clínico Universitario (Valencia), Hospital Duran i Reynals (L’Hospitalet de Llobregat), Hospital Morales Meseguer (Murcia), Hospital Virgen de la Arreixaca (Murcia), Hospital 12 de Octubre (Madrid), Hospital Carlos Haya (Málaga), Hospital Vall d’Hebron (Barcelona).

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This study was supported in part by Contract grant number: RD12/0020/1056 of RTICC, Instituto Carlos III, Spain.