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Successful outcomes of second hematopoietic stem cell transplantation with total nodal irradiation and ATG conditioning for graft failure in adult patients with severe aplastic anemia

Bone Marrow Transplantation volume 53, pages 1270–1277 (2018)Cite this article

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Abstract

Data regarding the optimal approach for second allogeneic hematopoietic stem cell transplantation (HSCT) after graft failure (GF) in acquired severe aplastic anemia (SAA) are still limited and heterogeneous. We examined 24 patients who underwent second HLA-matched sibling donor (MSD) peripheral blood HSCT for GF. The reconditioning regimen (TNI-750/ATG) consisted of a single dose of total nodal irradiation (TNI, 750 cGy) and antithymocyte globulin (ATG; Thymoglobulin®, 1.25 mg/kg/day for 3 days). All but one patient achieved successful engraftment of neutrophils (median 12 days, range 5–21) and platelets (median 15 days, range 9–316). Two patients with subsequent secondary GF achieved successful engraftment after a third HSCT from the same MSD. After a median follow-up of 57.4 months (range, 11.2–155.2), the 5-year overall survival and failure-free survival were 95.7% (95% confidence interval [CI] 87.7–100%) and 87.5% (95% CI 75.2–100%), respectively. One patient developed grade II acute graft-versus-host disease (GVHD), and the 2-year cumulative incidence of chronic GVHD was 23.5% (95% CI 8.1–43.5%). This study demonstrated successful outcomes following a second MSD HSCT in SAA after GF, and the results suggest TNI-750/ATG is a feasible reconditioning option. Future studies with larger cohorts will validate our results.

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Acknowledgements

We acknowledge all members at the Catholic Blood and Marrow Transplantation Center of Seoul St. Mary’s Hospital, Seoul, Korea, particularly the house staff and nurses, for excellent care of the patients.

Funding

This study was supported in part by Green Cross Corp, Korea.

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Authors and Affiliations

  1. Department of Hematology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    Seung-Ah Yahng

  2. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul. St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Sung-Soo Park, Young-Woo Jeon, Jae-Ho Yoon, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min, Hee-Je Kim, Seok-Goo Cho, Dong-Wook Kim, Woo-Sung Min & Jong Wook Lee

  3. Department of Hematology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Seung-Hwan Shin

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  1. Seung-Ah Yahng
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  16. Jong Wook Lee
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Contributions

SAY contributed to study design, patient management, and participated in data analysis and manuscript writing. JWL conceived of the idea and planned the clinical trial project, cared for patients, analyzed clinical data, and wrote the manuscript. SAY, SSP, YWJ, JHY, SHS, and SEL contributed to patient care and results analysis. KSE, YJK, SL, CKM, HJK, SGC, DWK, and WSM all took part in results analysis and reviewed the paper. All authors approved the final version of the manuscript. The corresponding author (JWL) had final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Jong Wook Lee.

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The authors declare that they have no conflict of interest.

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Yahng, SA., Park, SS., Jeon, YW. et al. Successful outcomes of second hematopoietic stem cell transplantation with total nodal irradiation and ATG conditioning for graft failure in adult patients with severe aplastic anemia. Bone Marrow Transplant 53, 1270–1277 (2018). https://doi.org/10.1038/s41409-018-0154-0

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