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Post-Transplant Events

Outcomes of a 1-day nonmyeloablative salvage regimen for patients with primary graft failure after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 47, pages 700–705 (2012)Cite this article

Abstract

Primary graft failure after allogeneic hematopoietic cell transplantation is a life-threatening complication. A shortened conditioning regimen may reduce the risk of infection and increase the chance of survival. Here, we report the outcome of 11 patients with hematologic diseases (median age, 44; range, 25–67 years, seven males) who received a 1-day reduced-intensity preparative regimen given as a re-transplantation for primary graft failure. The salvage regimen consisted of fludarabine, cyclophosphamide, alemtuzumab and TBI, all administered 1 day before re-transplantation. All patients received T-cell replete PBSCs from the same or a different haploidentical donor (n=10) or from the same matched sibling donor (n=1). Neutrophil counts promptly increased to >500/μL for 10 of the 11 patients at a median of 13 days. Of these, none developed grade III/IV acute GVHD. At present, 8 of the 11 patients are alive with a median follow-up of 11.2 months from re-transplantation and 5 of the 8 are in remission. In conclusion, this series suggests that our 1-day preparative regimen is feasible, leads to successful engraftment in a high proportion of patients, and is appropriate for patients requiring immediate re-transplantation after primary graft failure following reduced-intensity transplantation.

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Acknowledgements

The study investigators wish to thank the nurse practitioners, physician’s assistants, ward and clinic nurses, and staff of the Duke Adult Stem Cell Transplant Program for their outstanding care of the patients described in this report. JK is a Research Fellow of the Japan Society for the Promotion of Science. This work is supported in part by a Scholar in Clinical Research award from the Leukemia and Lymphoma Society (DAR), and NIH Grant P01-CA047741 (NJC).

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Authors and Affiliations

  1. Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    J Kanda, M E Horwitz, G D Long, C Gasparetto, K M Sullivan, J P Chute, A Morris, T Hennig, N J Chao & D A Rizzieri

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Z Li

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  1. J Kanda
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  2. M E Horwitz
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Correspondence to D A Rizzieri.

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Kanda, J., Horwitz, M., Long, G. et al. Outcomes of a 1-day nonmyeloablative salvage regimen for patients with primary graft failure after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 47, 700–705 (2012). https://doi.org/10.1038/bmt.2011.158

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