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Review
. 2024 Apr 22;15(1):111.
doi: 10.1186/s13287-024-03726-z.

Graft failure after allogeneic hematopoietic stem cell transplantation in pediatric patients with acute leukemia: autologous reconstitution or second transplant?

Tahereh Rostami  1 , Mohammad Reza Rostami  1 , Amir Hossein Mirhosseini  2 , Saeed Mohammadi  3 , Mohsen Nikbakht  3   4 , Hediyeh Alemi  4   5 , Naghmeh Khavandgar  4   5 , Soroush Rad  4 , Ghasem Janbabai  1 , Seied Asadollah Mousavi  4 , Azadeh Kiumarsi  6   7 , Amir Kasaeian  8   9   10
Affiliations
Review

Graft failure after allogeneic hematopoietic stem cell transplantation in pediatric patients with acute leukemia: autologous reconstitution or second transplant?

Tahereh Rostami et al. Stem Cell Res Ther. .

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.

Keywords: Acute leukemia; Disease-free survival; Graft failure; Hematopoietic stem cell transplantation; Myeloablative conditioning; Salvage transplantation.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Immunological basis of graft failure
Fig. 2
Fig. 2
Conditioning regimen for haploidentical hematopoietic stem cell transplant
Fig. 3
Fig. 3
Conditioning regimen for second transplant
See this image and copyright information in PMC

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