TY - JOUR
T1 - Mixed Chimerism and Secondary Graft Failure in Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia
T2 - Secondary Graft Failure in Transplantation for Aplastic Anemia
AU - Adult Aplastic Anemia Working Group of the Japanese Society for Hematopoietic Cell Transplantation
AU - Kako, Shinichi
AU - Yamazaki, Hirohito
AU - Ohashi, Kazuteru
AU - Ozawa, Yukiyasu
AU - Ota, Shuichi
AU - Kanda, Yoshinobu
AU - Maeda, Tetsuo
AU - Kato, Jun
AU - Ishiyama, Ken
AU - Matsuoka, Ken ichi
AU - Miyamoto, Toshihiro
AU - Iida, Hiroatsu
AU - Ikegame, Kazuhiro
AU - Fukuda, Takahiro
AU - Ichinohe, Tatsuo
AU - Atsuta, Yoshiko
AU - Mori, Takehiko
N1 - Funding Information:
The authors thank all the physicians and data managers who contributed valuable data on transplantation to TRUMP, especially those who participated in the additional survey. They also thank the staff of the Japanese Data Center for Hematopoietic Cell Transplantation for their assistance. Financial disclosure: This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED. Conflict of interest statement: H.Y. has received honoraria from Sanofi KK. Y.K. has received research funding from Sanofi KK and Shionogi. Financial disclosure: See Acknowledgments on page 450.
Funding Information:
The authors thank all the physicians and data managers who contributed valuable data on transplantation to TRUMP, especially those who participated in the additional survey. They also thank the staff of the Japanese Data Center for Hematopoietic Cell Transplantation for their assistance. Financial disclosure: This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED. Conflict of interest statement: H.Y. has received honoraria from Sanofi KK. Y.K. has received research funding from Sanofi KK and Shionogi.
Publisher Copyright:
© 2019 American Society for Transplantation and Cellular Therapy
PY - 2020/3
Y1 - 2020/3
N2 - Mixed chimerism (MC) and/or secondary graft failure (SGF) with recipient- or donor-type chimerism is a major obstacle in allogeneic transplantation for aplastic anemia (AA). From a registry database in Japan, patients with AA age >15 years who underwent a first allogeneic bone marrow or peripheral blood stem cell transplantation between 2000 and 2014 and achieved engraftment were included in this study. MC that did not require either granulocyte-colony stimulating factor (G-CSF) or transfusion support (group 1), MC (not SGF) that required G-CSF and/or transfusion support (group 2), SGF with MC or complete recipient-type chimerism (group 3), and SGF with complete donor-type chimerism (group 4) developed in 26, 16, 19, and 17 patients, respectively. The overall median duration of follow-up for survivors was 1727 days. The overall survival (OS) was 90.4% at 1 year and 83.5% at 5 years in patients without MC or SGF (n = 340), which was not different from the OS in groups 1 and 2. However, inferior OS was observed in group 3 (1 year, 52.1%; 5 years, 52.1%) and group 4 (1 year, 82.4%; 5 years, 56.3%). In multivariate analyses, the use of fludarabine (Flu) and the absence of irradiation in conditioning were associated with the development of SGF with MC or complete recipient-type chimerism, and the use of Flu in conditioning was associated with SGF with complete donor-type chimerism. In conclusion, the use of Flu may affect the occurrence of SGF with both recipient-type and donor-type chimerism.
AB - Mixed chimerism (MC) and/or secondary graft failure (SGF) with recipient- or donor-type chimerism is a major obstacle in allogeneic transplantation for aplastic anemia (AA). From a registry database in Japan, patients with AA age >15 years who underwent a first allogeneic bone marrow or peripheral blood stem cell transplantation between 2000 and 2014 and achieved engraftment were included in this study. MC that did not require either granulocyte-colony stimulating factor (G-CSF) or transfusion support (group 1), MC (not SGF) that required G-CSF and/or transfusion support (group 2), SGF with MC or complete recipient-type chimerism (group 3), and SGF with complete donor-type chimerism (group 4) developed in 26, 16, 19, and 17 patients, respectively. The overall median duration of follow-up for survivors was 1727 days. The overall survival (OS) was 90.4% at 1 year and 83.5% at 5 years in patients without MC or SGF (n = 340), which was not different from the OS in groups 1 and 2. However, inferior OS was observed in group 3 (1 year, 52.1%; 5 years, 52.1%) and group 4 (1 year, 82.4%; 5 years, 56.3%). In multivariate analyses, the use of fludarabine (Flu) and the absence of irradiation in conditioning were associated with the development of SGF with MC or complete recipient-type chimerism, and the use of Flu in conditioning was associated with SGF with complete donor-type chimerism. In conclusion, the use of Flu may affect the occurrence of SGF with both recipient-type and donor-type chimerism.
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U2 - 10.1016/j.bbmt.2019.10.004
DO - 10.1016/j.bbmt.2019.10.004
M3 - Article
C2 - 31618688
AN - SCOPUS:85076512355
SN - 1083-8791
VL - 26
SP - 445
EP - 450
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 3
ER -