Abstract
Graft failure is a fatal complication following allogeneic stem cell transplantation where a second transplantation is usually required for salvage. However, there are no recommended regimens for second transplantations for graft failure, especially in the haploidentical transplant setting. We recently reported encouraging outcomes using a novel method (haploidentical transplantation from a different donor after conditioning with fludarabine and cyclophosphamide). Herein, we report updated outcomes in 30 patients using this method. The median time of the second transplantation was 96.5 (33–215) days after the first transplantation. Except for one patient who died at +19d and before engraftment, neutrophil engraftments were achieved in all patients at 11 (8–24) days, while platelet engraftments were achieved in 22 (75.8%) patients at 17.5 (9–140) days. The 1-year OS and DFS were 60% and 53.3%, and CIR and TRM was 6.7% and 33.3%, respectively. Compared with the historical group, neutrophil engraftment (100% versus 58.5%, p < 0.001) and platelet engraftment (75.8% versus 32.3%, p < 0.001) were better in the novel regimen group, and OS was also improved (60.0% versus 26.4%, p = 0.011). In conclusion, salvage haploidentical transplantation from a different donor using the novel regimen represents a promising option to rescue patients with graft failure after the first haploidentical transplantation.
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The data used to support the findings of this study are available from the corresponding author upon request.
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Acknowledgements
This work was partly supported by the National Natural Science Foundation of China (grant no. 8227010768) and the National Key Research and Development Program of China (2021YFC2500300).
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X-JH and Y-QS contributed to the study design, and RM and Y-QS wrote the manuscript. In addition, all authors provided clinical or biological data, reviewed, and approved the manuscript.
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Ma, R., Zhu, DP., Zhang, XH. et al. Salvage haploidentical transplantation for graft failure after first haploidentical allogeneic stem cell transplantation: an updated experience. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02276-5
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DOI: https://doi.org/10.1038/s41409-024-02276-5