Virus reactivation and low dose of CD34+ cell, rather than haploidentical transplantation, were associated with secondary poor graft function within the first 100 days after allogeneic stem cell transplantation
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Secondary poor graft function (sPGF) is defined as secondary cytopenia after initial engraftment of allogeneic stem cell transplantation (allo-SCT). It has been shown to be associated with poor prognosis; however, there are very few reports on the incidence, risk factors, and outcomes of sPGF. Between January 2015 and December 2015, 564 patients, who received transplantation at Peking University People’s Hospital, were retrospectively reviewed. Among the 490 patients who achieved initial engraftment of both neutrophils and platelets, 28 patients developed sPGF. The cumulative incidence of sPGF on day 100 was 5.7%. The median time of sPGF was 54.5 (34–91) days after transplantation. Low (< median) CD34+ cell dose (p = 0.019, HR 3.07 (95% CI, 1.207–7.813)), Epstein-Barr Virus (EBV) reactivation (p = 0.009, HR 3.648 (95%CI, 1.382–9.629)), and cytomegalovirus (CMV) reactivation (p = 0.003, HR 7.827 (95%CI, 2.002–30.602)) were identified as independent risk factors for sPGF. There was no significant difference in PGF incidence between the matched sibling donor (MSD) group and haploidentical donor (HID) group (p = 0.44). The overall survival of patients with sPGF at 1 year after transplantation was significantly poorer than that of patients with good graft function (GGF) (50.5% versus 87.2%, p < 0.001). In conclusion, sPGF developed in 5.7% patients after allo-SCT, especially in patients with CMV, EBV reactivation, or infusion with a low dose of CD34+ cells. The prognosis of sPGF is still poor owing to a lack of standard treatment.
KeywordsPoor graft function Cytomegalovirus Graft-versus-host disease Allogeneic stem cell transplantation
This work was supported (in part) by the National Natural Science Foundation of China (Grant No. 81600103), the Key Program of National Natural Science Foundation of China (81530046), the Scientific Research Foundation for Capital Medicine Development (2016-1-4082), the Science and Technology Project of Guangdong Province of China (2016B030230003), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81621001), and the National Key Research and Development Program of China (2017YFA0104500).
Compliance with ethical standards
The Ethics Committee of the Peking University People’s Hospital approved this study. All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments, or with some comparable ethical standards. All patients gave written informed consent.
Conflict of interest
The authors declare that they have no conflicts of interest.
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