Second allogeneic haematopoietic stem cell transplantation for graft failure. Experience of a national bone marrow transplant centre, Tunis.

Ref ID: 18565

Author:

S. Ladeb (1), A. Lakhal (1), W. Barhoumi (1), N. Ben Abdejlil (1),
L. Torjman (1), A. Ben Abdeladhim (1), S. Hmida (2),
T. Ben Othman (1)

Author address:

(1)Centre National De Greffe De Moelle Osseuse (Tunis, TN);
(2)Centre National de Transfusion sanguine (Tunis, TN)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Introduction and objectives: Patients who undergo allogeneic
hematopoietic stem cell transplantation (HSCT) may suffer
from engraftment failure (EF) or graft rejection (GR). A second
HSCT may be the only therapeutic option. We aimed to report
associated complications and overall survival.
Patients and Methods: Data on patients who suffered from EF
or GR after a 1st HSCT, and who underwent a second HLA
-matched related HSCT between April 1999 and December
2010 were recorded.
Results: Twenty one patients underwent a 2nd HSCT. Diagnosis was acquired aplastic anemia in 12 patients, Fanconi
anemia (FA) in 3 patients, acute leukemia in 1 patient and supposed FA which was not confi rmed thereafter in 5 patients. All
received bone marrow (BM) graft for the 1st transplant. The
2nd HSCT was performed for EF in 5 patients and for GR in
16 patients. The median time between the fi rst and the second
HSCT was 11 months (1.75- 68). The conditioning regimens
used were Cyclophosphamide200-ATGAM90 (n=13) Cyclophosphamide100-ATGAM90 (n=3) and fl udarabine containing
regimens (n=4). One patient was not conditioned. Seventeen
patients received peripheral blood stem cell (PBSC) grafts and
four BM grafts from the same donors. The median number of
CD 34+ PBSC/kg was 4.5 x10
6
(1.65-10×10
6
). Twenty patients
engrafted (95.2%). One patient died on day 0 of the 2nd transplant from DMSO toxicity and was not assessable for engraftment. Graft rejection occurred in 2 patients, respectively on day
30 and day 75 post 2nd transplant and was followed by death
from invasive sinusal aspergillosis on day 171 in the 2nd patient. Grade IV acute GVHD occurred in 2 patients and induced
death in one of them on day 80. Extensive cGVHD occured in
1 patient after 21 months from transplant. Toxicity related mortality was 14%. After a median follow-up of 50 months (0-138)
after 2nd transplant, 18 patients (86%) are alive with a good
performans status and a normal blood count.
Conclusion: As it is relatively safe and it offers a real chance to
cure, 2nd allogeneic HSCT should be offered to patients who
don’t engraft or who reject their fi rst graft.

Abstract Number: P672

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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