Primary graft failure following allogeneic hematopoietic stem cell transplantation: risk factors, treatment and outcomes

Figures & data

Table 1. Characteristics of primary PGF (A) and GR (B) patients.

A.
Number	Gender	Age	Disease	Donor type	Risk stratification	Disease state	MRD	splenomegaly	SF (ng/ml)	MNC (*10^8/kg)	CD34^+ (*10^6/kg)
1	Male	29	AML	MUD	Standard	PR	Positive	No	912.70	6.80	5.70
2	Male	45	AML	HRD	High	CR	Positive	No	1805.00	8.02	4.89
3	Male	39	AML	HRD	Standard	NR	Positive	Yes	1027.50	8.89	3.83
4	Female	41	MDS	MSD	Standard	/	/	No	1664.00	11.02	2.09
5	Male	24	ALL	HRD	Standard	CR	Negative	No	1138.30	7.27	3.35
6	Male	38	ALL	HRD	Standard	CR	Positive	No	793.30	7.44	4.58
7	Male	35	ALL	HRD	High	CR	Negative	Yes	913.50	13.45	2.13
8	Male	39	MDS	HRD	High	/	Positive	Yes	424.70	18.57	2.44
9	Male	13	MPN	HRD	Low	/	Positive	No	62.90	7.46	2.85
10	Male	56	MDS	HRD	High	/	Positive	No	1883.00	10.64	1.50
11	Male	37	AML	MSD	High	PR	Positive	Yes	1434.60	10.00	3.00
12	Male	35	AML	MSD	High	PR	Positive	Yes	2080.00	9.00	2.52
13	Female	33	AML	HRD	High	NR	Positive	Yes	943.00	8.74	3.23
14	Female	39	AML	HRD	High	CR	Negative	Yes	28.30	19.13	5.02
15	Male	53	Lymphoma	MUD	High	/	Positive	No	1922.00	6.24	2.99
16	Male	21	MDS	MSD	Standard	/	/	Yes	477.50	8.00	3.60
17	Female	27	AML	HRD	Standard	CR	Negative	No	1855.00	12.00	2.28
18	Female	39	AML	HRD	High	CR	Negative	Yes	384.10	8.00	4.40
19	Male	28	AML	MSD	Standard	CR	Negative	Yes	2469.00	7.89	2.38
B.
Number	Gender	Age	Disease	Donor type	Risk stratification	Disease state	MRD	splenomegaly	SF (ng/ml)	MNC (*10^8/kg)	CD34^+ (*10^6/kg)
1	Male	8	AA	HRD	/	/	/	No	304.50	10.00	2.10
2	Male	8	AA	HRD	/	/	/	No	465.40	6.79	3.51
3	Male	27	MDS	HRD	High	/	Positive	Yes	1414.70	13.46	2.02
4	Female	53	MPN	HRD	/	/	/	Yes	78.80	8.00	3.20
5	Male	26	MDS	HRD	Standard	/	/	No	4946.00	7.99	7.63
6	Male	17	ALL	MUD	Standard	CR	Negative	Yes	903.40	7.43	4.31
7	Female	31	ALL	MUD	High	CR	Negative	No	912.00	8.00	9.52
8	Female	45	MDS	HRD	Standard	CR	Negative	No	130.00	8.00	3.20
9	Female	59	MPN	HRD	/	/	/	Yes	180.80	4.35	3.83
10	Female	44	AML	MSD	High	NR	Positive	Yes	2039.00	7.77	3.11
11	Male	18	AA	HRD	/	/	/	No	911.10	8.00	2.48

MRD indicates minimal residual disease; SF, serum ferritin; MNC, mononuclear cell; AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasm; AA, aplastic anemia; CR, complete remission; PR, partial remission; NR, No remission; HRD, HLA-haploidentical related donor; MUD, matched unrelated donor; MSD, matched sibling donor.

Table 2. Univariate analysis of risk factors for primary PGF (A) and GR (B).

A
Risk factors		PGF	Non-PGF	P
Disease	AL	13	57	0.671
	MDS	4	16
	Lymphoma	1	2
	MPN	1	1
Splenomegaly	Yes	10	18	0.013
	No	9	58
Donor type	Non-MSD	14	24	0.001
	MSD	5	52
Gender-mismatch	Yes	7	41	0.182
	No	12	35
Bloodtype-mismatch	Yes	13	26	0.007
	No	6	50
TBI in pre-condition	Yes	5	16	0.853
	No	14	60
GVHD prophylaxis	FK506	7	41	0.182
	CSA	12	35
SF(>1000 ng/ml)	Yes	10	23	0.080
	No	9	51
Time before transplantation	>6months	13	30	0.023
	≤6months	6	46
CMV infection in 30d	Yes	1	1	0.858
	No	18	75
aGVHD in 30d	Yes	7	14	0.155
	No	12	62
MNC (*10^8/kg)	Median (range)	8.74 (6.24–19.13)	8.59 (4.85–20.83)	0.791
CD34^+(*10^6/kg)	Median (range)	3.00 (1.5–5.7)	3.06 (1.80–7.50)	0.952
Donor age(years)	Median (range)	33 (14–60)	36 (8–60)	0.739
B
Risk factors		GR	non-GR	P
Disease	AL	3	27	0.083
	MDS	3	8
	AA	3	8
	MPN	2	1
Splenomegaly	Yes	5	8	0.132
	No	6	36
Donor type	Non-MSD	10	17	0.002
	MSD	1	27
Gender-mismatch	Yes	5	28	0.449
	No	6	16
Bloodtype-mismatch	Yes	3	16	0.832
	No	8	28
TBI in pre-condition	Yes	2	11	0.937
	No	9	33
GVHD prophylaxis	FK506	5	13	0.518
	CSA	6	31
SF(>1000 ng/ml)	Yes	3	16	0.832
	No	8	28
Time before transplantation	>6m	4	20	0.838
	≤6m	7	24
CMV infection in 30d	Yes	3	3	0.160
	No	8	41
aGVHD in 30d	Yes	5	7	0.087
	No	6	37
MNC (*10^8/kg)	Median (range)	8.00 (4.35–13.46)	8.00 (4.58–13.20)	0.413
CD34^+(*10^6/kg)	Median (range)	3.20 (2.02–9.52)	3.30 (2.09–7.24)	0.949
Donor age(years)	Median (range)	29 (15–53)	35.5 (11–56)	0.312

PGF indicates poor graft function; GR, graft failure; GVHD, graft versus host disease; aGVHD, acute GVHD; AL, acute leukemia; MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasm; MSD, matched sibling donor; TBI, total body irradiation; SF, serum ferritin; CMV, cytomegalovirus; MNC, mononuclear cell.

Table 3. Multivariate logistic analysis of risk factors for primary PGF (A) and GR (B).

A
Potential risk factors	P	OR	95% CI
Splenomegaly	0.030	3.486	1.139	13.109
Donor type(non-MSD)	0.018	4.475	1.289	15.537
Bloodtype-mismatch	0.132
SF(>1000 ng/ml)	0.153
Time before transplantation (>6months)	0.096
B
Potential risk factors	P	OR	95% CI
Donor type(non-MSD)	0.020	19.432	1.595	236.691
aGVHD in 30d	0.544
Disease	0.161

MSD indicates matched sibling donor; aGVHD, acute GVHD; SF, serum ferritin.

Figure 1. Survival analysis of patients with PGF (A) and GR (B).