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. 2023 Jun;102(6):1561-1567.
doi: 10.1007/s00277-023-05206-5. Epub 2023 Apr 21.

Poor graft function after haploidentical stem cell transplantation with post-transplant cyclophosphamide

Ignacio Gómez-Centurión #  1   2 , Reyes Maria Martin Rojas #  3   4 , Rebeca Bailén  3   4 , Cristina Muñoz  3   4 , Santiago Sabell  3   4 , Gillen Oarbeascoa  3   4 , Paula Fernández-Caldas  3   4 , Diego Carbonell  3   4 , Jorge Gayoso  3   4 , Carolina Martínez-Laperche  3   4 , Ismael Buño  3   4   5 , Javier Anguita  3   4 , José Luis Díez-Martin  3   4 , Mi Kwon  3   4
Affiliations

Poor graft function after haploidentical stem cell transplantation with post-transplant cyclophosphamide

Ignacio Gómez-Centurión et al. Ann Hematol. 2023 Jun.

Abstract

This is a retrospective cohort study of consecutive adult patients who received a haploidentical-SCT (haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) in a single centre. Poor graft function (PGF) was defined as the occurrence of either persistent neutropenia (ANC < 0.5 × 109/µL) with poor response to granulocyte colony-stimulating factors (G-CSF) and/or thrombocytopenia (platelets < 20 × 109/L) with transfusion dependence, with complete donor chimerism and without concurrent severe GVHD or underlying disease relapse, during the first 12 months after transplantation. Forty-four (27.5%) out of 161 patients were diagnosed with PGF. Previous CMV reactivation was significantly more frequent in patients with PGF (88.6% versus 73.5%, p = 0.04) and the number of reactivations was also higher in these patients. Besides, early CMV reactivations in the first 6 months post-SCT were also significantly more frequent among patients with PGF (88.6% versus 71.8% p = 0.025). Thirty-two percent of patients with PGF were treated with increasing doses of thrombopoietin-receptor agonists (TRA) and 7 patients were treated with a donor CD34 + selected boost. In total, 93.2% of patients reached adequate peripheral blood counts in a median time of 101 days (range 11-475) after diagnosis. PGF is a frequent complication after haplo-SCT with PT-Cy. CMV reactivation might be the most relevant factor associated to its development. Even when most patients recover peripheral counts with support therapy, there is a group of patients with persistent cytopenias who can effectively be treated with TRA and/or a boost of CD34 + selective cells.

Keywords: Haploidentical SCT; Poor graft function; Post-transplantation cyclophosphamide.

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References

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