دورية أكاديمية
Graft Failure Incidence, Risk Factors, and Outcomes in Patients Undergoing Non-Myeloablative Allogeneic Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide.
| العنوان: | Graft Failure Incidence, Risk Factors, and Outcomes in Patients Undergoing Non-Myeloablative Allogeneic Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide. |
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| المؤلفون: | Mata JR; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland., Zahurak M; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland., Rosen N; Division of Hematology and Medical Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., DeZern AE; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland., Jones RJ; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland., Ambinder AJ; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: aambind1@jhmi.edu. |
| المصدر: | Transplantation and cellular therapy [Transplant Cell Ther] 2024 Jun; Vol. 30 (6), pp. 588-596. Date of Electronic Publication: 2024 Mar 22. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101774629 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2666-6367 (Electronic) Linking ISSN: 26666367 NLM ISO Abbreviation: Transplant Cell Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York] : Elsevier Inc., [2021]- |
| مواضيع طبية MeSH: | Hematopoietic Stem Cell Transplantation*/adverse effects , Cyclophosphamide*/therapeutic use , Graft vs Host Disease*/epidemiology , Graft vs Host Disease*/prevention & control , Transplantation, Homologous*/adverse effects, Humans ; Female ; Male ; Risk Factors ; Middle Aged ; Adult ; Retrospective Studies ; Incidence ; Aged ; Adolescent ; Treatment Outcome ; Graft Rejection/prevention & control ; Graft Rejection/epidemiology ; Young Adult ; Immunosuppressive Agents/therapeutic use ; Immunosuppressive Agents/adverse effects ; Transplantation Conditioning/methods |
| مستخلص: | Graft failure (GF) is a major complication of allogeneic hematopoietic cell transplantation (alloHCT) that results in significant morbidity and mortality. Post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis has emerged as an effective regimen across the spectrum of donor-match settings, but few studies have investigated the characteristics of GF in the setting of PTCy-based GVHD prophylaxis. The objective was to detail the incidence, clinical features, risk factors, and outcomes for patients with primary graft failure (PGF) and secondary graft failure (SGF). In this retrospective study at a single institution, 958 consecutive patients undergoing first nonmyeloablative (NMA) alloHCT with PTCy-based GVHD prophylaxis were analyzed. PGF was defined as a failure to achieve an ANC ≥ 500 cells/m 3 by day 30 of transplant in the absence of residual disease. SGF was defined as complete loss of donor chimerism after initial engraftment. The incidences of PGF and SGF were 3.8% (n = 37) and 1.8% (n = 17), respectively. Neither PGF nor SGF were associated with HLA disparity. In a multivariate analysis, risk factors for PGF in this cohort included age ≥ 65 (OR 2.4, 95% CI 1.2 to 4.8, P = .0120), an underlying diagnosis of MDS, MPN, or MDS/MPN overlap (OR 2.8, 95% CI 1.4 to 5.7, P = .0050), post-transplant viremia with HHV-6 (OR 2.9, 95% CI 1.5 to 5.7, P = .0030), and low CD34+ dose (OR 0.7, 95% CI 0.5 to 0.9, P = .0080). Patients with PGF had poor overall survival, driven primarily by a high rate of nonrelapse mortality (59% at 36 months). SGF was associated with use of a bone marrow graft source and a diagnosis of Hodgkin lymphoma. Patients with SGF had excellent clinical outcomes with only one of seventeen patients experiencing relapse and relapse-related mortality. The incidence of PGF and SGF in patients receiving NMA conditioning and PTCy is low and is not impacted by HLA disparities between donors and recipients. PGF is more common in recipients with age ≥ 65, a diagnosis of MDS, MPN, or MDS/MPN-overlap, post-transplant HHV-6 viremia, and low CD34+ cell dose. Low total nucleated cell dose is also a risk factor for PGF in patients receiving a bone marrow graft source. Patients who experience PGF have poor outcomes due to high rates of nonrelapse mortality, whereas patients who experience SGF have excellent long-term outcomes. (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Allogeneic hematopoietic cell transplant; graft failure; non-myeloablative conditioning; post-transplant cyclophosphamide |
| المشرفين على المادة: | 8N3DW7272P (Cyclophosphamide) 0 (Immunosuppressive Agents) |
| تواريخ الأحداث: | Date Created: 20240323 Date Completed: 20240530 Latest Revision: 20240530 |
| رمز التحديث: | 20240531 |
| DOI: | 10.1016/j.jtct.2024.03.018 |
| PMID: | 38521411 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2666-6367 |
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| DOI: | 10.1016/j.jtct.2024.03.018 |