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Treatment of poor graft function after allogeneic hematopoietic cell transplantation with a booster of CD34-selected cells infused without conditioning

Bone Marrow Transplantation volume 49, pages 720–721 (2014)Cite this article

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Graft failure (GF) after allo-SCT is a serious complication with high mortality.1, 2 Discrimination between rejection and poor graft function (PGF) can be made by chimerism analysis. In rejection, chimerism status is mixed, with the presence of recipient cells, whereas full donor chimerism is present in PGF. In patients with rejection, a second transplant preceded by a conditioning regimen should be considered.1, 2, 3

PGF may be transient if caused by CMV infection or by drugs—for instance, ganciclovir.4 In this case, supportive therapy and growth factors can be used until clearance of CMV infection or change of therapy has ensued. If the PGF endures, however, the prognosis is dismal with infections or organ failure being a predictable outcome, which can only be avoided by a second transplant.5 Importantly, patients with PGF may not need conditioning before a second transplant with the same donor, as they possess the donor's immune system. Use of booster infusions has previously been reported with some promising results, albeit several studies used BM as booster source, chimerism studies were often absent, and CD34+ selection was not always performed.4, 5, 6, 7, 8, 9

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Authors and Affiliations

  1. Department Of Hematology, National University Hospital, Copenhagen, Denmark

    B Askaa, L Vindeløv & H Sengeløv

  2. Department of Clinical Immunology, National University Hospital, Copenhagen, Denmark

    A Fischer-Nielsen & E K Haastrup

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  1. B Askaa
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  2. A Fischer-Nielsen
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  3. L Vindeløv
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Correspondence to H Sengeløv.

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Askaa, B., Fischer-Nielsen, A., Vindeløv, L. et al. Treatment of poor graft function after allogeneic hematopoietic cell transplantation with a booster of CD34-selected cells infused without conditioning. Bone Marrow Transplant 49, 720–721 (2014). https://doi.org/10.1038/bmt.2014.5

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