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Primary graft failure after myeloablative allogeneic hematopoietic cell transplantation for hematologic malignancies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, S-14186 Stockholm, Sweden..
Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
Ann & Robert H Lurie Childrens Hosp Chicago, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplant, Chicago, IL USA..
Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
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2015 (English)In: Leukemia, ISSN 0887-6924, E-ISSN 1476-5551, Vol. 29, no 8, 1754-1762 p.Article in journal (Refereed) Published
Abstract [en]

Clinical outcomes after primary graft failure (PGF) remain poor. Here we present a large retrospective analysis (n = 23 272) which investigates means to prevent PGF and early detection of patients at high risk. In patients with hematologic malignancies, who underwent their first myeloablative allogeneic hematopoietic cell transplantation, PGF was reported in 1278 (5.5%), and there was a marked difference in PGFs using peripheral blood stem cell compared with bone marrow grafts (2.5 vs 7.3%; P<0.001). A fourfold increase of PGF was observed in myeloproliferative disorders compared with acute leukemia (P<0.001). Other risk factors for PGF included recipient age <30, HLA mismatch, male recipients of female donor grafts, ABO incompatibility, busulfan/cyclophosphamide conditioning and cryopreservation. In bone marrow transplants, total nucleated cell doses <= 2.4 x 10(8) per kg were associated with PGF (odds ratio 1.39; P<0.001). The use of tacrolimus-based immunosuppression and granulocyte colony-stimulating factor were associated with decreased PGF risk. These data, allow clinicians to do more informed choices with respect to graft source, donor selection, conditioning and immunosuppressive regimens to reduce the risk of PGF. Moreover, a novel risk score determined on day 21 post transplant may provide the rationale for an early request for additional hematopoietic stem cells.

Place, publisher, year, edition, pages
2015. Vol. 29, no 8, 1754-1762 p.
National Category
Cancer and Oncology
URN: urn:nbn:se:uu:diva-264326DOI: 10.1038/leu.2015.75ISI: 000360937200015PubMedID: 25772027OAI: oai:DiVA.org:uu-264326DiVA: diva2:861122
Swedish Society for Medical Research (SSMF)
Available from: 2015-10-15 Created: 2015-10-09 Last updated: 2015-10-15Bibliographically approved

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