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Allografting

Graft failure in the modern era of allogeneic hematopoietic SCT

A Corrigendum to this article was published on 03 April 2013

Abstract

Graft failure may contribute to increased morbidity and mortality after allogeneic hematopoietic SCT (allo-HSCT). Here, we present risk factors for graft failure in all first allo-HSCTs performed at our center from 1995 to mid-2010 (n=967). Graft failure was defined as >95% recipient cells any time after engraftment with no signs of relapse, or re-transplantation because of primary or secondary neutropenia (<0.5 × 109/L) and/or thrombocytopenia (<30 × 109/L). Fifty-four patients (5.6%) experienced graft failure. The majority were because of autologous reconstitution (n=43), and only a few patients underwent re-transplantation because of primary (n=6) or secondary (n=5) graft failures. In non-malignant disorders, graft failure had no effect on survival, whereas in malignant disease graft failure was associated with reduced 5-year survival (22 vs 53%, P<0.01). In multivariate analysis, ex vivo T-cell depletion (relative risk (RR) 8.82, P<0.001), HLA-mismatched grafts (RR 7.64, P<0.001), non-malignant disorders (RR 3.32, P<0.01) and reduced-intensity conditioning (RR 2.58, P<0.01) increased the risk for graft failure, whereas graft failures were prevented by total nucleated cell doses of 2.5 × 108/kg (RR 0.36, P<0.01). In conclusion, graft failure was only associated with inferior survival in malignant disease. Non-malignant disorders, HLA match, conditioning intensity, immunosuppression regimen and cell dose all influenced graft failure risk.

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Acknowledgements

We thank the nursing staff at the Center for Allo-SCT, and at the Departments of Hematology and Pediatrics, Karolinska University Hospital, Stockholm. The study was supported by grants from the Swedish Cancer Society (0070-B06-20XBC), the Children’s Cancer Foundation (06/094), the Swedish Research Council (K2007-64X-05971-27-1), the Cancer Society in Stockholm, the David and Astrid Hagelén Foundation, the Swedish Society for Medical Research (SSMF), the Swedish Medical Society, and Karolinska Institutet.

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Olsson, R., Remberger, M., Schaffer, M. et al. Graft failure in the modern era of allogeneic hematopoietic SCT. Bone Marrow Transplant 48, 537–543 (2013). https://doi.org/10.1038/bmt.2012.239

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Keywords

  • allogeneic
  • hematopoietic SCT
  • graft failure
  • risk factors

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