期刊
BONE MARROW TRANSPLANTATION
卷 48, 期 4, 页码 537-543出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/bmt.2012.239
关键词
allogeneic; hematopoietic SCT; graft failure; risk factors
资金
- Swedish Cancer Society [0070-B06-20XBC]
- Children's Cancer Foundation [06/094]
- Swedish Research Council [K2007-64X-05971-27-1]
- Cancer Society in Stockholm
- David and Astrid Hagelen Foundation
- Swedish Society for Medical Research (SSMF)
- Swedish Medical Society
- Karolinska Institutet
Graft failure may contribute to increased morbidity and mortality after allogeneic hematopoietic SCT (allo-HSCT). Here, we present risk factors for graft failure in all first allo-HSCTs performed at our center from 1995 to mid-2010 (n=967). Graft failure was defined as >95% recipient cells any time after engraftment with no signs of relapse, or re-transplantation because of primary or secondary neutropenia (<0.5 x 10(9)/L) and/or thrombocytopenia (<30 x 10(9)/L). Fifty-four patients (5.6%) experienced graft failure. The majority were because of autologous reconstitution (n=43), and only a few patients underwent re-transplantation because of primary (n=6) or secondary (n=5) graft failures. In non-malignant disorders, graft failure had no effect on survival, whereas in malignant disease graft failure was associated with reduced 5-year survival (22 vs 53%, P<0.01). In multivariate analysis, ex vivo T-cell depletion (relative risk (RR) 8.82, P<0.001), HLA-mismatched grafts (RR 7.64, P<0.001), non-malignant disorders (RR 3.32, P<0.01) and reduced-intensity conditioning (RR 2.58, P<0.01) increased the risk for graft failure, whereas graft failures were prevented by total nucleated cell doses of >= 2.5 x 10(8)/kg (RR 0.36, P<0.01). In conclusion, graft failure was only associated with inferior survival in malignant disease. Non-malignant disorders, HLA match, conditioning intensity, immunosuppression regimen and cell dose all influenced graft failure risk. Bone Marrow Transplantation (2013) 48, 537-543; doi: 10.1038/bmt.2012.239; published online 10 December 2012
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