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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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.
The authors declare no conflict of interest.
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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
- hematopoietic SCT
- graft failure
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