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Transplant Toxicities

Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI

Bone Marrow Transplantation volume 51, pages 687–691 (2016)Cite this article

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Abstract

Graft failure remains a severe complication of hematopoietic stem cell transplantation (HSCT). Several risk factors have already been published. In this study, we re-evaluated them in a large cohort who had the benefit of the recent experience in HSCT (2006–2012). Data from 4684 unrelated donor HSCT from 2006 to 2012 were retrospectively collected from centers belonging to the French Society for Stem Cell Transplantation. Among the 2716 patients for whom HLA typing was available, 103 did not engraft leading to a low rate of no engraftment at 3.8%. In univariate analysis, only type of disease and status of disease at transplant for malignant diseases remained significant risk factors (P=0.04 and P<0.0001, respectively). In multivariate analysis, only status of disease was a significant risk factor (P<0.0001). Among the 61 patients who did not engraft and who were mismatched for 1 HLA class I and/or HLA-DP, 5 donor-specific antibodies (DSAs) were detected but only 1 was clearly involved in graft failure, for the others their role was more questionable. Second HSCT exhibited a protective although not statistically significant effect on OS (hazard ratio=0.57 [0.32–1.02]). In conclusion, only one parameter (disease status before graft) remains risk factor for graft failure in this recent cohort.

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Acknowledgements

We would like to thank the members of the Société Française de Greffe de Moelle and de Thérapie cellulaire (SFGM-TC), the SFGM-TC data manager Nicole Raus and all collaborators who contributed to patient recruitment, data registration and quality control of the study. This work was supported by grant from IRGHET.

Author contributions

TC collected and analyzed data. TC and PL wrote the manuscript. KD and JL performed the statistical analysis and contributed to the redaction of the manuscript. NR sent data capture forms to the centers, collected clinical data from questionnaires and performed the extraction of clinical data. JLT performed HLA antibodies detection. RPdL and PL have been the supervisors of the study. RPdL, PL, JLT, KD, JL, NR, PvE, DC, PP, MF, IJ, VD, FD and CP read and commented on the manuscript.

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Authors and Affiliations

  1. Service d’hématologie adulte, Hôpital Saint-Louis, APHP, Paris, France

    T Cluzeau

  2. Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Nice, France

    T Cluzeau

  3. Hôpital Saint-Louis, Service de Biostatistique et Information Médicale, APHP, Paris, France

    J Lambert & K Dessaux

  4. Data Management of SFGM-TC, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

    N Raus

  5. Laboratory of Histocompatibility, EFS Saint Etienne, Saint Etienne, France

    L Absi

  6. Laboratory of Histocompatibility, EFS Henri Mondor, Créteil, France

    F Delbos

  7. Laboratory of Histocompatibility, EFS Pays de la Loire, Nantes, France

    A Devys

  8. Laboratory of Immunology, CHU Nice, Nice, France

    M De Matteis

  9. Laboratory of Histocompatibility, EFS Rhone Alpes, Lyon, France

    V Dubois

  10. Laboratory of Immunology, CHU Limoges, France

    M Filloux

  11. Laboratory of Immunology, CHU Toulouse, Toulouse, France

    M Fort

  12. Laboratory of Histocompatibility, EFS Normandie, Rouen, France

    F Hau

  13. Laboratory of Histocompatibility, EFS CA, Poitiers, France

    I Jollet

  14. Laboratory of Immunology, CHU Lille, Lille, France

    M Labalette

  15. Laboratory of Histocompatibility, EFS Rhône Alpes, Grenoble, France

    D Masson

  16. Laboratory of Histocompatibility, CHU Brest, France

    B Mercier

  17. Laboratory of Immunology, Hôpital Robert Debré, APHP, Paris, France

    B Pedron

  18. Laboratory of Histocompatibility, CHU Nancy, Nancy, France

    P Perrier

  19. Laboratory of Histocompatibility, EFS Alpes Mediterrannée, Marseille, France

    C Picard

  20. Laboratory of Histocompatibility, EFS Clermont-Ferrand, Clermont-Ferrand, France

    F Quainon

  21. Laboratory of Immunology, Hôpital Saint-Eloi, Montpellier, France

    A Ramounau-Pigot

  22. Laboratory of Histocompatibility, EFS Rennes, France

    V Renac

  23. Laboratory of Immunology, CHU Necker-Enfants Malades, Paris, France

    P Van Endert

  24. Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis, APHP, Labex Transplantex, Paris, France

    D Charron & P Loiseau

  25. Service d’hématologie greffe, Hôpital Saint-Louis, APHP, Paris, France

    R Peffault de la Tour

  26. Laboratory of Immunology and Immunogenetics, CNRS UMR 5164, CHU Bordeaux, France

    J L Taupin

  27. INSERM U1160, Hôpital Saint-Louis, Paris, France

    P Loiseau

Authors
  1. T Cluzeau
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  2. J Lambert
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  3. N Raus
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  4. K Dessaux
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  5. L Absi
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  6. F Delbos
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  7. A Devys
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  8. M De Matteis
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  9. V Dubois
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  10. M Filloux
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  11. M Fort
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  12. F Hau
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  13. I Jollet
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  14. M Labalette
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  15. D Masson
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  16. B Mercier
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  17. B Pedron
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  18. P Perrier
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  19. C Picard
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  20. F Quainon
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  21. A Ramounau-Pigot
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  22. V Renac
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  23. P Van Endert
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  24. D Charron
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  26. J L Taupin
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  27. P Loiseau
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Corresponding author

Correspondence to P Loiseau.

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Cluzeau, T., Lambert, J., Raus, N. et al. Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI. Bone Marrow Transplant 51, 687–691 (2016). https://doi.org/10.1038/bmt.2015.351

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