Second allogeneic haematopoietic stem cell transplantation for graft failure. Experience of a national bone marrow transplant centre, Tunis.
Introduction and objectives: Patients who undergo allogeneic hematopoietic stem cell transplantation (HSCT) may suffer from engraftment failure (EF) or graft rejection (GR). A second HSCT may be the only therapeutic option. We aimed to report associated complications and overall survival. Patients and Methods: Data on patients who suffered from EF or GR after a 1st HSCT, and who underwent a second HLA â€“matched related HSCT between April 1999 and December 2010 were recorded. Results: Twenty one patients underwent a 2nd HSCT. Diagnosis was acquired aplastic anemia in 12 patients, Fanconi anemia (FA) in 3 patients, acute leukemia in 1 patient and supposed FA which was not con64257; rmed thereafter in 5 patients. All received bone marrow (BM) graft for the 1st transplant. The 2nd HSCT was performed for EF in 5 patients and for GR in 16 patients. The median time between the 64257; rst and the second HSCT was 11 months (1.75- 68). The conditioning regimens used were Cyclophosphamide200-ATGAM90 (n=13) Cyclophosphamide100-ATGAM90 (n=3) and 64258; udarabine containing regimens (n=4). One patient was not conditioned. Seventeen patients received peripheral blood stem cell (PBSC) grafts and four BM grafts from the same donors. The median number of CD 34+ PBSC/kg was 4.5 x10 6 (1.65-10x10 6 ). Twenty patients engrafted (95.2%). One patient died on day 0 of the 2nd transplant from DMSO toxicity and was not assessable for engraftment. Graft rejection occurred in 2 patients, respectively on day 30 and day 75 post 2nd transplant and was followed by death from invasive sinusal aspergillosis on day 171 in the 2nd patient. Grade IV acute GVHD occurred in 2 patients and induced death in one of them on day 80. Extensive cGVHD occured in 1 patient after 21 months from transplant. Toxicity related mortality was 14%. After a median follow-up of 50 months (0â€“138) after 2nd transplant, 18 patients (86%) are alive with a good performans status and a normal blood count. Conclusion: As it is relatively safe and it offers a real chance to cure, 2nd allogeneic HSCT should be offered to patients who donâ€™t engraft or who reject their 64257; rst graft.
Full conference title:
Annual Meeting of the EBMT, 38th