Abstract
Graft failure is a serious and often life-threatening complication of allogeneic stem cell transplantation (SCT). A second SCT with intensified immunosuppression is the main therapeutic option. However, primary graft failure without autoreconstitution after unrelated SCT or cord blood transplantation (CBT) is often an urgent issue because of a high risk of infection and the difficulty of an early retransplantation from original donors. In this study, we analyzed the outcome of retransplantation following graft failure. From 1995 to 2000, 7 patients with graft failure were retransplanted. Five had nonmalignant disorders, including 1 multiply transfused patient with severe aplastic anemia. Six patients had primary graft failure and 1 had secondary graft failure. Four patients with graft failure after related SCTs were retransplanted from the same donors. Three with graft failure after unrelated SCTs (including 2 CBTs) were retransplanted from HLA-2-or-3-mismatched related donors, 2 of whom received positively selected CD34+ blood cells. Conditioning regimens for the second transplant were intensified by using total body irradiation (TBI) or fludarabine. All except 1 patient, who had been alloimmunized by multiple transfusions, had a successful engraftment following the second transplant. In conclusion : 1) graft failures were successfully treated with retransplantation; 2) TBI and fludarabine are effective for immunosuppression in retransplantation ; and 3) retransplantation of positively selected CD34+ cells from HLA-mismatched related donors is a useful treatment for graft failure following unrelated SCT.
