Peripheral Blood as a Preferable Source of Stem Cells for Salvage Transplantation in Patients with Graft Failure after Cord Blood Transplantation: A Retrospective Analysis of the Registry Data of the Japanese Society for Hematopoietic Cell Transplantation

Abstract

To compare the different stem cell sources used in salvage transplantation for graft failure (GF) after cord blood transplantation (CBT), we retrospectively analyzed data of 220 patients who developed GF after undergoing CBT between January 2001 and December 2007 and underwent a second hematopoietic stem cell transplantation (HSCT) within 3 months. The donor sources for salvage HSCT were cord blood (n = 180), peripheral blood stem cells (PBSCs; n = 24), and bone marrow (BM; n = 16). The cumulative incidence of neutrophil engraftment on day 30 after the second HSCT was 39% with CB, 71% with PBSCs, and 75% with BM. Multivariate analysis revealed that PBSC and BM grafts were associated with a significantly higher engraftment rate than CB (hazard ratio [HR], 7.77; P < .001 and HR, 2.81; P = .016, respectively). Although the incidence of grade II-IV acute graft-versus-host disease was significantly higher in the PBSC group than in the CB group (HR, 2.83; P = .011), the incidence of 1-year nonrelapse mortality was lower in the PBSC group than in the CB group (HR, 0.43; P = .019), and 1-year overall survival was superior in the PBSC group compared with the CB group (HR, 0.45; P = .036). Our results suggest that PBSC is the preferable source of stem cells in salvage HSCT for GF after CBT.

Salvage allogeneic hematopoietic SCT for primary graft failure in children

“…A previous report including a small number of pediatric pGF patients showed an advantage of PBSC from mismatched related donors, 19 whereas our analysis demonstrated that CBT provided a survival rate similar to that of HSCT from mismatched related donors. The survival curve for CBT was superimposed on the curve for HSCT from a mismatched related donor, although engraftment achievement tended to be lower and engraftment was late.…”

“…However, a recent study on engraftment probability of salvage CBT for pGF showed that a small fraction of children had a worse outcome than salvage HSCT from a mismatched related donor. 19 Another study on salvage CBT for pGF reported the association of cell dose of 42.5 Â 10 7 cells/kg with a better outcome. 13 In our cohort, the median TNC count of CB was 5.4 Â 10 7 cells/kg, which was considerably higher than that reported previously.…”

“…8 Salvage HSCT can rescue pGF patients, [9][10][11][12][13][14] and recent studies on adult pGF patients have showed the feasibility of using reduced-intensity conditioning containing fludarabine (FLU) and low-dose irradiation, 13,[15][16][17] including short-term preconditioning regimen 10,18 and an advantage of PBSC as the stem cell source for salvage HSCT. 19,20 However, the management of pGF patients is usually difficult because of their poor clinical status. Owing to the rarity of pGF and emergent condition of the patients, prospective controlled trials are difficult and the optimal preconditioning regimen and stem cell source have not been established.…”

Early peripheral blood and T-cell chimerism dynamics after umbilical cord blood transplantation supported with haploidentical cells

“…BM chimerism on day þ 30 of these cases showed a median of 100% of CB cells (range 75-100%). Median time to neutrophil engraftment in this group was 19 days (range [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…[9][10][11] Outcome of patients who develop graft failure without a second transplantation is dismal with survival rates lower than 10%; 12 however, survival rates improve significantly to 30-60% after salvage transplantation using reduced intensity conditioning regimens. [13][14][15] From the extensive experience with CB transplantation, various risk factors have been associated with CB graft failure. [16][17][18] Once transplantation has been performed, early detection of graft failure is important to start rapid therapeutic measures such as immunomodulation and to launch a second transplant when appropriate as soon as possible.…”