Abstract
Graft failure (GF) remains a major problem in cord blood transplantation (CBT). In 36 adult patients undergoing CBT at our hospital between July 2003 and December 2009, six patients developed GF (primary, n = 5; secondary, n = 1). All six patients underwent second stem cell transplantation (SCT). Three patients had acute myeloid leukemia, one had acute lymphoblastic leukemia, one had chronic myeloid leukemia, and one had aplastic anemia. Five patients were complicated with sepsis before the second SCT. The median elapsed time from first CBT to the diagnosis of primary GF was 27 days. Secondary GF was diagnosed on day 567. The median elapsed time from primary GF to second SCT was 9 days. In the patient with secondary GF, the elapsed time was 35 days. Cord blood grafts were used in 5 patients and a matched sibling donor in one patient. All 6 patients underwent second transplantation following a modified ‘1-day’-based preparative regimen consisting of fludarabine (30 mg/m2, 1 day, n = 2; 2 days, n = 1; 3 days, n = 3), cyclophosphamide (2 g/m2), and total body irradiation (2 Gy). All patients achieved neutrophil engraftment, and the median elapsed time from second SCT to engraftment was 35 days. Four patients remain alive between 5 and 38 months after second SCT. ‘1-day’-based short-term conditioning may be a promising salvage regimen.
Similar content being viewed by others
References
Uchida N, Wake A, Takagi S, Yamamoto H, Kato D, Matsuhashi Y, Matsumura T, et al. Umbilical cord blood transplantation after reduced-intensity conditioning for elderly patients with hematologic diseases. Biol Blood Marrow Transplant. 2008;14:583–90.
Rodrigues CA, Sanz G, Brunstein CG, Sanz J, Wagner JE, Renaud M, et al. Analysis of risk factors for outcomes after unrelated cord blood transplantation in adults with lymphoid malignancies: a study by the Eurocord-Netcord and lymphoma working party of the European group for blood and marrow transplantation. J Clin Oncol. 2009;27:256–63.
Narimatsu H, Kami M, Miyakoshi S, Murashige N, Yuji K, Hamaki T, et al. Graft failure following reduced-intensity cord blood transplantation for adult patients. Br J Haematol. 2006;132:36–41.
Mattsson J, Ringdén O, Storb R. Graft failure after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2008;14:165–70.
Rondón G, Saliba RM, Khouri I, Giralt S, Chan K, Jabbour E, et al. Long-term follow-up of patients who experienced graft failure postallogeneic progenitor cell transplantation. Results of a single institution analysis. Biol Blood Marrow Transplant. 2008;14:859–66.
Shimizu I, Kobayashi H, Nasu K, Otsuki F, Ueki T, Sumi M, et al. Successful engraftment of cord blood following a one-day reduced-intensity conditioning regimen in two patients suffering primary graft failure and sepsis. Bone Marrow Transplant. 2009;44:617–8.
Yamashita T, Sugimori C, Ishiyama K, Yamazaki H, Okumura H, Kondo Y, et al. Cord blood transplantation using minimum conditioning regimens for patients with hematologic malignancies complicated by severe infections. Int J Hematol. 2009;89:238–42.
Lang P, Mueller I, Greil J, Bader P, Schumm M, Pfeiffer M, et al. Retransplantation with stem cells from mismatched related donors after graft rejection in pediatric patients. Blood Cells Mol Dis. 2008;40:33–9.
Jabbour E, Rondon G, Anderlini P, Giralt SA, Couriel DR, Champlin RE, et al. Treatment of donor graft failure with nonmyeloablative conditioning of fludarabine, antithymocyte globulin and a second allogeneic hematopoietic transplantation. Bone Marrow Transplant. 2007;40:431–5.
Ohwada C, Nakaseko C, Ozawa S, Takeuchi M, Shono K, Koizumi M, et al. Second cord blood transplantation (CBT) with reduced-intensity conditioning for graft failure after the first CBT for AML. Bone Marrow Transplant. 2004;34:999–1000.
Kawamori Y, Yakushijin K, Okamura A, Nishikawa S, Minagawa K, Shimoyama M, et al. Successful engraftment in reduced-intensity cord blood transplantation (CBT) as a salvage therapy for graft failure after primary CBT in adults. Transplantation. 2007;83:1281–2.
Byrne BJ, Horwitz M, Long GD, Gasparetto C, Sullivan KM, Chute J, et al. Outcomes of a second non-myeloablative allogeneic stem cell transplantation following graft rejection. Bone Marrow Transplant. 2008;41:39–43.
Tanaka T, Matsubara H, Adachi S, Chang H, Fujino H, Higashi Y, et al. Second transplantation from HLA 2-loci-mismatched mother for graft failure due to hemophagocytic syndrome after cord blood transplantation. Int J Hematol. 2004;80:467–9.
Tanaka H, Ohwada C, Sakaida E, Takeda Y, Abe D, Oda K, et al. Successful engraftment by second cord blood transplantation with reduced-intensity conditioning after graft rejection due to hemophagocytic syndrome following initial CBT. Bone Marrow Transplant. 2007;40:995–6.
Fernandes J, Rocha V, Robin M, de Latour RP, Traineau R, Devergie A, et al. Second transplant with two unrelated cord blood units for early graft failure after haematopoietic stem cell transplantation. Br J Haematol. 2007;137:248–51.
Gyurkocza B, Cao TM, Storb RF, Lange T, Leisenring W, Franke GN, et al. Salvage allogeneic hematopoietic cell transplantation with fludarabine and low-dose total body irradiation after rejection of first allografts. Biol Blood Marrow Transplant. 2009;15:1314–22.
Goggins TF, Rizzeri DA, Prosnitz R, Gasparetto C, Long G, Horwitz ME, et al. One day preparative regimen for allogeneic non-myeloablative stem cell transplantation (NMST) using 3–5/6 matched related donors. Blood. 2003;102:476b–7b.
Moscardó F, Sanz J, Senent L, Cantero S, de la Rubia J, Montesinos P, et al. Impact of hematopoietic chimerism at day +14 on engraftment after unrelated donor umbilical cord blood transplantation for hematologic malignancies. Haematologica. 2009;94:827–32.
Chan KW, Grimley MS, Taylor C, Wall DA. Early identification and management of graft failure after unrelated cord blood transplantation. Bone Marrow Transplant. 2008;42:35–41.
Guardiola P, Kuentz M, Garban F, Blaise D, Reiffers J, Attal M, et al. Second early allogeneic stem cell transplantations for graft failure in acute leukaemia, chronic myeloid leukaemia and aplastic anaemia. French Society of Bone Marrow Transplantation. Br J Haematol. 2000;111:292–302.
Walshe J, Bishop MR. Factors affecting engraftment of allogeneic hematopoietic stem cells after reduced-intensity conditioning. Cytotherapy. 2004;6:589–92.
Ogata M, Satou T, Kawano R, Takakura S, Goto K, Ikewaki J, et al. Correlations of HHV-6 viral load and plasma IL-6 concentration with HHV-6 encephalitis in allogeneic stem cell transplant recipients. Bone Marrow Transplant. 2010;45:129–36.
Muta T, Fukuda T, Harada M. Human herpesvirus-6 encephalitis in hematopoietic SCT recipients in Japan: a retrospective multicenter study. Bone Marrow Transplant. 2009;43:583–5.
Ogata M. Human herpesvirus 6 in hematological malignancies. J Clin Exp Hematop. 2009;49:57–67.
Zerr DM, Corey L, Kim HW, Huang ML, Nguy L, Boeckh M. Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation. Clin Infect Dis. 2005;40:932–40.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Sumi, M., Shimizu, I., Sato, K. et al. Graft failure in cord blood transplantation successfully treated with short-term reduced-intensity conditioning regimen and second allogeneic transplantation. Int J Hematol 92, 744–750 (2010). https://doi.org/10.1007/s12185-010-0714-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12185-010-0714-6