Hematopoietic Cell Transplantation with Cryopreserved Grafts for Severe Aplastic Anemia

Abstract

With the COVID-19 pandemic and the ensuing barriers to the collection and transport of donor cells, it is often necessary to collect and cryopreserve grafts before initiation of transplantation conditioning. The effect on transplantation outcomes in nonmalignant disease is unknown. This analysis examined the effect of cryopreservation of related and unrelated donor grafts for transplantation for severe aplastic anemia in the United States during 2013 to 2019. Included are 52 recipients of cryopreserved grafts who were matched for age, donor type, and graft type to 194 recipients who received noncryopreserved grafts. Marginal Cox regression models were built to study the effect of cryopreservation and other risk factors associated with outcomes. We recorded higher 1-year rates of graft failure (hazard ratio [HR], 2.26; 95% confidence interval, 1.17 to 4.35; P = .01) and of 1-year overall mortality (HR, 3.13; 95% CI, 1.60 to 6.11; P = .0008) after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% (95% CI, 60% to 84%) in the cryopreserved graft group and 91% (95% CI, 86% to 94%) in the noncryopreserved graft group. These data support the use of noncryopreserved grafts whenever possible in patients with severe aplastic anemia.

Fresh vs. frozen allogeneic peripheral blood stem cell grafts: A successful timely option

“…Regarding the occurrence of GVHD we must point out that our findings are in contrast with the recent CIBMTR study which demonstrated no difference in aGVHD and cGVHD between cryopreserved and fresh grafts for aplastic anemia patients in particular, however in their study they did observe higher rates of graft failure with cryopreservation, 19 a phenomenon which we did not observe. Another recent CIBMTR study that included 274 patients with hematological malignancy receiving PTCy as GVHD prophylaxis demonstrated similar rates of GVHD as well as survival outcomes and engraftment parameters compared to fresh grafts in a manner similar to the present study, 20 although our study included a variety of GVHD prophylaxis regimens.…”

Coronavirus disease 2019 pandemic and allogeneic hematopoietic stem cell transplantation: a single center reappraisal

“…Nonetheless, this might not be true in every clinical setting. In particular, Eapen et al have recently reported an increased incidence of graft failure and 1-year mortality in SAA patients receiving cryopreserved grafts [27] . Given the short follow-up of patients transplanted with cryopreserved grafts at our center, we could explore only short-term transplant outcomes.…”

Variable CD34+ recovery of cryopreserved allogeneic HPC products: transplant implications during the COVID-19 pandemic

“…Registry studies suggest that cryopreservation itself may not alter clinical outcomes, with the exception of transplantation for severe aplastic anemia. 10 - 12 However, the effect of precryopreservation conditions was not examined in these studies.…”