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Stem cell transplantation

Primary graft failure after myeloablative allogeneic hematopoietic cell transplantation for hematologic malignancies

Leukemia volume 29, pages 1754–1762 (2015)Cite this article

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Abstract

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 × 108 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.

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Acknowledgements

RFO thanks the Swedish Society for Medical Research (SSMF), the Swedish Medical Society, the Centre for Clinical Research Sörmland, the David and Astrid Hagelén’s Foundation and the Karolinska Institutet for their financial support. The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research; and grants from Actinium Pharmaceuticals; Allos Therapeutics, Inc.; Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; Blue Cross and Blue Shield Association; Celgene Corporation; Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Fresenius-Biotech North America, Inc.; Gamida Cell Teva Joint Venture Ltd.; Genentech, Inc.; Gentium SpA; Genzyme Corporation; GlaxoSmithKline; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Jeff Gordon Children’s Foundation; Kiadis Pharma; The Leukemia & Lymphoma Society; Medac GmbH; The Medical College of Wisconsin; Merck & Co, Inc.; Millennium: The Takeda Oncology Co.; Milliman USA, Inc.; Miltenyi Biotec, Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; Perkin Elmer, Inc.; Remedy Informatics; Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; St. Baldrick’s Foundation; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; Tarix Pharmaceuticals; TerumoBCT; Teva Neuroscience, Inc.; THERAKOS, Inc.; University of Minnesota; University of Utah; and Wellpoint, Inc.

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Author notes

  1. J R Schriber and K R Cooke: These authors contributed equally as senior authors.

Authors and Affiliations

  1. Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    R F Olsson & O T H Ringdén

  2. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

    R F Olsson

  3. Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA

    B R Logan, X Zhu & M C Pasquini

  4. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    B R Logan

  5. Division of Pediatric Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    S Chaudhury

  6. Section of Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA

    G Akpek

  7. Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA

    B J Bolwell

  8. The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    C N Bredeson

  9. Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA

    C C Dvorak

  10. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    V Gupta

  11. Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    V T Ho

  12. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    H M Lazarus

  13. Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK

    D I Marks

  14. Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, AZ, USA

    J R Schriber

  15. Arizona Oncology, Scottsdale, AZ, USA

    J R Schriber

  16. Pediatric Blood and Marrow Transplantation Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    K R Cooke

  17. Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden

    O T H Ringdén

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  1. R F Olsson
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  2. B R Logan
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  3. S Chaudhury
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  9. V Gupta
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  10. V T Ho
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  11. H M Lazarus
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  14. M C Pasquini
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  15. J R Schriber
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  16. K R Cooke
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Correspondence to R F Olsson.

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Olsson, R., Logan, B., Chaudhury, S. et al. Primary graft failure after myeloablative allogeneic hematopoietic cell transplantation for hematologic malignancies. Leukemia 29, 1754–1762 (2015). https://doi.org/10.1038/leu.2015.75

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