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The incidence, risk factors, and outcomes of primary poor graft function after unmanipulated haploidentical stem cell transplantation

Annals of Hematology volume 94, pages 1699–1705 (2015)Cite this article

Abstract

Primary poor graft function (PGF) is a severe complication after allogeneic stem cell transplantation (SCT). The incidence, risk factors, and outcomes of PGF have not been well described, especially in the haploidentical SCT setting. We retrospectively reviewed patients who received haploidentical SCT at Peking University Institute of Hematology between January 1, 2011, and December 31, 2012. PGF was defined as persistent neutropenia (≤0.5 × 109 L−1), thrombocytopenia (platelets ≤20 × 109 L−1), and/or hemoglobin ≤70 g L−1 after engraftment with hypocellular bone marrow and full donor chimerism, without concurrent graft-versus-host disease or disease relapse. Incidence was calculated from all patients. Of the 464 total patients, 26 (5.6 %) developed primary PGF. The risk factors were analyzed and compared with control patients with good graft function who were selected using the case-pair method. Finally, 104 patients were selected as a control group according to the matching conditions: (1) the type (acute leukemia, myelodysplastic syndrome (MDS), chronic myelogenous leukemia (CML)) and status (standard risk, high risk) of underlying disease, (2) sex, (3) year in which the transplantation was received, and (4) a 1:4 ratio of case-control. No factors were found to be associated with primary PGF. Compared to cases with good graft function, patients with primary PGF experienced poor overall survival (34.6 vs. 82.7 %, p < 0.001). Of the 26 primary PGF patients, only nine achieved hematopoietic recovery and survived. In conclusion, primary PGF is a rare but life-threatening complication after haploidentical SCT, and effective therapies need to be explored.

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Acknowledgments

This work was supported (in part) by the National High Technology Research and Development Program of China (Program 863) (Grant No. 2013AA020401), The Key Program of National Natural Science Foundation of China (Grant No. 81230013), and the Scientific Research Foundation for Capital Medicine Development (Grant No. 2011-4022-08). We thank the editage (https://www.editage.com/) for the assistance in editing the manuscript.\

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Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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    Authors and Affiliations

    1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People’s Republic of China

      Yu-Qian Sun, Gan-Lin He, Ying-Jun Chang, Lan-Ping Xu, Xiao-Hui Zhang, Wei Han, Huan Chen, Yu-Hong Chen, Yu Wang, Feng-Rong Wang, Jing-Zhi Wang, Kai-Yan Liu & Xiao-Jun Huang

    2. Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China

      Xiao-Jun Huang

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    1. Yu-Qian Sun
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    Correspondence to Xiao-Jun Huang.

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    Yu-Qian Sun and Gan-Lin He contributed equally to this work.

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    Cite this article

    Sun, YQ., He, GL., Chang, YJ. et al. The incidence, risk factors, and outcomes of primary poor graft function after unmanipulated haploidentical stem cell transplantation. Ann Hematol 94, 1699–1705 (2015). https://doi.org/10.1007/s00277-015-2440-x

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    • DOI: https://doi.org/10.1007/s00277-015-2440-x

    Keywords

    • Graft function
    • Haploidentical
    • Stem cell transplantation
    • Human leukocyte antigen