Abstract
Graft failure remains a severe complication of hematopoietic stem cell transplantation (HSCT). Several risk factors have already been published. In this study, we re-evaluated them in a large cohort who had the benefit of the recent experience in HSCT (2006–2012). Data from 4684 unrelated donor HSCT from 2006 to 2012 were retrospectively collected from centers belonging to the French Society for Stem Cell Transplantation. Among the 2716 patients for whom HLA typing was available, 103 did not engraft leading to a low rate of no engraftment at 3.8%. In univariate analysis, only type of disease and status of disease at transplant for malignant diseases remained significant risk factors (P=0.04 and P<0.0001, respectively). In multivariate analysis, only status of disease was a significant risk factor (P<0.0001). Among the 61 patients who did not engraft and who were mismatched for 1 HLA class I and/or HLA-DP, 5 donor-specific antibodies (DSAs) were detected but only 1 was clearly involved in graft failure, for the others their role was more questionable. Second HSCT exhibited a protective although not statistically significant effect on OS (hazard ratio=0.57 [0.32–1.02]). In conclusion, only one parameter (disease status before graft) remains risk factor for graft failure in this recent cohort.
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Acknowledgements
We would like to thank the members of the Société Française de Greffe de Moelle and de Thérapie cellulaire (SFGM-TC), the SFGM-TC data manager Nicole Raus and all collaborators who contributed to patient recruitment, data registration and quality control of the study. This work was supported by grant from IRGHET.
Author contributions
TC collected and analyzed data. TC and PL wrote the manuscript. KD and JL performed the statistical analysis and contributed to the redaction of the manuscript. NR sent data capture forms to the centers, collected clinical data from questionnaires and performed the extraction of clinical data. JLT performed HLA antibodies detection. RPdL and PL have been the supervisors of the study. RPdL, PL, JLT, KD, JL, NR, PvE, DC, PP, MF, IJ, VD, FD and CP read and commented on the manuscript.
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Cluzeau, T., Lambert, J., Raus, N. et al. Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI. Bone Marrow Transplant 51, 687–691 (2016). https://doi.org/10.1038/bmt.2015.351
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DOI: https://doi.org/10.1038/bmt.2015.351
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