Outcome of Second Transplantation Using Umbilical Cord Blood for Graft Failure after Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia

Yasushi Onishi, Takehiko Mori, Shinichi Kako, Hideo Koh, Naoyuki Uchida, Tadakazu Kondo, Takeshi Kobayashi, Hiromasa Yabe, Toshihiro Miyamoto, Koji Kato, Ritsuro Suzuki, Shinji Nakao, Hirohito Yamazaki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Graft failure (GF) is the most critical life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia, for which a second transplantation is the only effective treatment. Optimal procedures have not been established for the second transplantation in this setting, however. Here we retrospectively analyzed the outcomes of 22 patients with aplastic anemia, age ≥16 years, who underwent umbilical cord blood transplantation for GF after the first HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median age of patients was 36 years (range, 16 to 72 years), and the median time from the first to the second transplant was 77 days (range, 29 to 1061 days). The cumulative incidence of neutrophil engraftment at day 60 post-transplantation was 45.5% (95% confidence interval [CI], 23.6% to 65.0%). With a median follow-up of 50 months, the 4-year overall survival (OS) was 38.5% (95% CI, 18.4% to 58.5%). Mycofenolate mofetil-based graft-versus-host disease prophylaxis demonstrated greater neutrophil recovery than prophylaxis with calcineurin inhibitor alone or methotrexate-based prophylaxis (66.7% versus 37.5%; P = .04). The use of such conditioning regimens as fludarabine + melphalan or cyclophosphamide + low-dose total body irradiation was associated with better engraftment (58.3% versus 30%; P = .05) and better 4-year OS (55.6% versus 20%; P = .05) than other regimens. Although further investigation is needed, umbilical cord blood could be an effective and promising option for stem cell source for urgent second transplantation in patients with aplastic anemia who develop GF after the first HSCT.

Original languageEnglish
JournalBiology of Blood and Marrow Transplantation
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Aplastic Anemia
Hematopoietic Stem Cell Transplantation
Fetal Blood
Transplantation
Transplants
Neutrophils
Confidence Intervals
Melphalan
Survival
Whole-Body Irradiation
Cell Transplantation
Graft vs Host Disease
Methotrexate
Cyclophosphamide
Registries
Japan
Stem Cells
Databases
Incidence

Keywords

  • Aplastic anemia
  • Cord blood transplantation
  • Graft failure
  • Second transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Outcome of Second Transplantation Using Umbilical Cord Blood for Graft Failure after Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia. / Onishi, Yasushi; Mori, Takehiko; Kako, Shinichi; Koh, Hideo; Uchida, Naoyuki; Kondo, Tadakazu; Kobayashi, Takeshi; Yabe, Hiromasa; Miyamoto, Toshihiro; Kato, Koji; Suzuki, Ritsuro; Nakao, Shinji; Yamazaki, Hirohito.

In: Biology of Blood and Marrow Transplantation, 2017.

Research output: Contribution to journalArticle

Onishi, Yasushi ; Mori, Takehiko ; Kako, Shinichi ; Koh, Hideo ; Uchida, Naoyuki ; Kondo, Tadakazu ; Kobayashi, Takeshi ; Yabe, Hiromasa ; Miyamoto, Toshihiro ; Kato, Koji ; Suzuki, Ritsuro ; Nakao, Shinji ; Yamazaki, Hirohito. / Outcome of Second Transplantation Using Umbilical Cord Blood for Graft Failure after Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia. In: Biology of Blood and Marrow Transplantation. 2017.
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abstract = "Graft failure (GF) is the most critical life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia, for which a second transplantation is the only effective treatment. Optimal procedures have not been established for the second transplantation in this setting, however. Here we retrospectively analyzed the outcomes of 22 patients with aplastic anemia, age ≥16 years, who underwent umbilical cord blood transplantation for GF after the first HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median age of patients was 36 years (range, 16 to 72 years), and the median time from the first to the second transplant was 77 days (range, 29 to 1061 days). The cumulative incidence of neutrophil engraftment at day 60 post-transplantation was 45.5{\%} (95{\%} confidence interval [CI], 23.6{\%} to 65.0{\%}). With a median follow-up of 50 months, the 4-year overall survival (OS) was 38.5{\%} (95{\%} CI, 18.4{\%} to 58.5{\%}). Mycofenolate mofetil-based graft-versus-host disease prophylaxis demonstrated greater neutrophil recovery than prophylaxis with calcineurin inhibitor alone or methotrexate-based prophylaxis (66.7{\%} versus 37.5{\%}; P = .04). The use of such conditioning regimens as fludarabine + melphalan or cyclophosphamide + low-dose total body irradiation was associated with better engraftment (58.3{\%} versus 30{\%}; P = .05) and better 4-year OS (55.6{\%} versus 20{\%}; P = .05) than other regimens. Although further investigation is needed, umbilical cord blood could be an effective and promising option for stem cell source for urgent second transplantation in patients with aplastic anemia who develop GF after the first HSCT.",
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T1 - Outcome of Second Transplantation Using Umbilical Cord Blood for Graft Failure after Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia

AU - Onishi, Yasushi

AU - Mori, Takehiko

AU - Kako, Shinichi

AU - Koh, Hideo

AU - Uchida, Naoyuki

AU - Kondo, Tadakazu

AU - Kobayashi, Takeshi

AU - Yabe, Hiromasa

AU - Miyamoto, Toshihiro

AU - Kato, Koji

AU - Suzuki, Ritsuro

AU - Nakao, Shinji

AU - Yamazaki, Hirohito

PY - 2017

Y1 - 2017

N2 - Graft failure (GF) is the most critical life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia, for which a second transplantation is the only effective treatment. Optimal procedures have not been established for the second transplantation in this setting, however. Here we retrospectively analyzed the outcomes of 22 patients with aplastic anemia, age ≥16 years, who underwent umbilical cord blood transplantation for GF after the first HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median age of patients was 36 years (range, 16 to 72 years), and the median time from the first to the second transplant was 77 days (range, 29 to 1061 days). The cumulative incidence of neutrophil engraftment at day 60 post-transplantation was 45.5% (95% confidence interval [CI], 23.6% to 65.0%). With a median follow-up of 50 months, the 4-year overall survival (OS) was 38.5% (95% CI, 18.4% to 58.5%). Mycofenolate mofetil-based graft-versus-host disease prophylaxis demonstrated greater neutrophil recovery than prophylaxis with calcineurin inhibitor alone or methotrexate-based prophylaxis (66.7% versus 37.5%; P = .04). The use of such conditioning regimens as fludarabine + melphalan or cyclophosphamide + low-dose total body irradiation was associated with better engraftment (58.3% versus 30%; P = .05) and better 4-year OS (55.6% versus 20%; P = .05) than other regimens. Although further investigation is needed, umbilical cord blood could be an effective and promising option for stem cell source for urgent second transplantation in patients with aplastic anemia who develop GF after the first HSCT.

AB - Graft failure (GF) is the most critical life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia, for which a second transplantation is the only effective treatment. Optimal procedures have not been established for the second transplantation in this setting, however. Here we retrospectively analyzed the outcomes of 22 patients with aplastic anemia, age ≥16 years, who underwent umbilical cord blood transplantation for GF after the first HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median age of patients was 36 years (range, 16 to 72 years), and the median time from the first to the second transplant was 77 days (range, 29 to 1061 days). The cumulative incidence of neutrophil engraftment at day 60 post-transplantation was 45.5% (95% confidence interval [CI], 23.6% to 65.0%). With a median follow-up of 50 months, the 4-year overall survival (OS) was 38.5% (95% CI, 18.4% to 58.5%). Mycofenolate mofetil-based graft-versus-host disease prophylaxis demonstrated greater neutrophil recovery than prophylaxis with calcineurin inhibitor alone or methotrexate-based prophylaxis (66.7% versus 37.5%; P = .04). The use of such conditioning regimens as fludarabine + melphalan or cyclophosphamide + low-dose total body irradiation was associated with better engraftment (58.3% versus 30%; P = .05) and better 4-year OS (55.6% versus 20%; P = .05) than other regimens. Although further investigation is needed, umbilical cord blood could be an effective and promising option for stem cell source for urgent second transplantation in patients with aplastic anemia who develop GF after the first HSCT.

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KW - Cord blood transplantation

KW - Graft failure

KW - Second transplantation

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