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Successful rescue transplant for children with primary graft failure using early intervention with a single day preparative regimen and related haploidentical donor

Bone Marrow Transplantation volume 56, pages 2031–2033 (2021)Cite this article

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Engraftment is crucial to restore effective hematopoiesis and achieve immune reconstitution after a hematopoietic stem cell transplant (HSCT). Though the incidence of primary graft failure is low, it is associated with very poor outcomes due to high rates of infection and bleeding complications [1, 2]. There is limited published rescue strategies for management of graft failure in children [2, 3]. We adopted a two-prong strategy of early identification of graft failure and a quick salvage transplant with a single day conditioning regimen and related haploidentical donor. It was previously used in a small group of adult patients [4], which we applied in four pediatric patients with graft failure.

A retrospective review of patients treated for graft failure with rescue transplant between 2012 and 2019 at British Columbia Children’s Hospital (Vancouver, Canada) was performed with the approval of the Institutional Research Ethics Board. Patients were defined as having primary graft failure if they did not achieve an absolute neutrophil count of > 0.5 × 109/L for 3 consecutive days by 28 days with a marrow graft or up to 42 days with cord blood grafts and in the absence of donor cell engraftment (<5% donor cells by whole blood chimerism testing- FISH or PCR based). All patients underwent bone marrow evaluation to confirm marrow aplasia (cellularity of <10% by morphology) and to rule out relapse in case of malignancy.

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  1. Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Divya Subburaj, Amanda M. Li, Jacob Rozmus & Kirk R. Schultz

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  1. Divya Subburaj
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  2. Amanda M. Li
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Correspondence to Divya Subburaj.

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Subburaj, D., Li, A.M., Rozmus, J. et al. Successful rescue transplant for children with primary graft failure using early intervention with a single day preparative regimen and related haploidentical donor. Bone Marrow Transplant 56, 2031–2033 (2021). https://doi.org/10.1038/s41409-021-01309-7

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