Graft Failure After Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients With Acute Leukemia: Autologous Reconstitution or Second Transplant? Publisher Pubmed



Rostami T¹ ; Rostami MR¹ ; Mirhosseini AH² ; Mohammadi S³ ; Nikbakht M^{3, 4} ; Alemi H^{4, 5} ; Khavandgar N^{4, 5} ; Rad S⁴ ; Janbabai G¹ ; Mousavi SA⁴ ; Kiumarsi A^{1, 6} ; Kasaeian A^{4, 5, 7}
Source: Stem Cell Research and Therapy Published:2024

Abstract

Background: Graft failure (GF) is a rare but serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Prevention of graft failure remains the most advisable approach as there is no clear recommendation for the best strategies for reversing this complication. Administration of growth factor, additional hematopoietic progenitor boost, or a salvage HSCT are current modalities recommended for the treatment of GF. Autologous recovery without evidence of disease relapse occurs rarely in patients with GF, and in the absence of autologous recovery, further salvage transplantation following a second conditioning regimen is a potential treatment option that offers the best chances of long-term disease-free survival. The preconditioning regimens of second HSCT have a significant impact on engraftment and outcome, however, currently there is no consensus on optimal conditioning regimen for second HSCT in patients who have developed GF. Furthermore, a second transplant from a different donor or the same donor is still a matter of debate. Observations: We present our experience in managing pediatric patients with acute leukemia who encountered graft failure following stem cell transplantation. Conclusions and relevance: Although a second transplantation is almost the only salvage method, we illustrate that some pediatric patients with acute leukemia who experience graft failure after an allogeneic stem cell transplant using Myeloablative conditioning (MAC) regimen may achieve long-term disease-free survival through autologous hematopoiesis recovery. © The Author(s) 2024.