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Second haploidentical stem cell transplantation for primary graft failure

Bone Marrow Transplantation volume 56, pages 1291–1296 (2021)Cite this article

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Abstract

We report the outcome of 19 patients who experienced primary graft failure (PrGF) after a haploidentical (HAPLO), unmanipulated bone marrow transplant. The median age of patients was 52 years; the conditioning regimen of the first HAPLO transplant was either full dose total body irradiation (TBI) or fludarabine, busulfan, and thiotepa (TBF); PTCY was given to all patients together with cyclosporine and mycophenolate. All 19 patients with PrGF received a second HAPLO graft, at a median interval of 42 days (34–82) after HSCT, using the Baltimore protocol and G-CSF mobilized PB from the same (n = 13) or another HAPLO family donor (n = 6). GvHD prophylaxis was again PTCY-based; 14/19 patients had trilineage recovery (74%) and 1-year survival was 66%. Engraftment at second HAPLO was seen in 7/8 patient with, and in 5/7 patients without donor-specific antibodies (DSA). In a multivariate logistic regression analysis on the original group of 503 patients, there was a trend for a reduced dose of busulfan, to increase the risk of PrGF (p = 0.1). In conclusion, patients with PrGF following a HAPLO transplant, can be rescued with a second early HAPLO transplant, using the same or a different donor.

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Fig. 1: 1-years OS in patients with PrGF.

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Acknowledgements

This study was supported by AIRC, Milano, Grant to AB.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy

    Sabrina Giammarco, Patrizia Chiusolo, Federica Sora, Simona Sica, Luca Laurenti, Elisabetta Metafuni, Idanna Innocenti, Francesco Autore & Andrea Bacigalupo

  2. IRCCS Policlinico San Martino IST, Genova, Italy

    Anna Maria Raiola, Carmen Di Grazia, Stefania Bregante, Francesca Gualandi, Riccardo Varaldo & Emanuele Angelucci

  3. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy

    Patrizia Chiusolo, Federica Sora, Simona Sica, Luca Laurenti & Andrea Bacigalupo

  4. Italian Bone Marrow Donor Registry (IBMDR), Ospedale Galliera, Genova, Italy

    Barbara Murgia

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  1. Sabrina Giammarco
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Correspondence to Sabrina Giammarco.

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Giammarco, S., Raiola, A.M., Di Grazia, C. et al. Second haploidentical stem cell transplantation for primary graft failure. Bone Marrow Transplant 56, 1291–1296 (2021). https://doi.org/10.1038/s41409-020-01183-9

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