Rostami Tahereh, Rostami Mohammad Reza, Mirhosseini Amir Hossein, Mohammadi Saeed, Nikbakht Mohsen, Alemi Hediyeh, Khavandgar Naghmeh, Rad Soroush, Janbabai Ghasem, Mousavi Seied Asadollah, Kiumarsi Azadeh, Kasaeian Amir
Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, School of Medicine, Imam Ali Hospital, Alborz University of Medical Sciences, Alborz, Iran.
Stem Cell Res Ther. 2024 Apr 22;15(1):111. doi: 10.1186/s13287-024-03726-z.
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.
We present our experience in managing pediatric patients with acute leukemia who encountered graft failure following stem cell transplantation.
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.
移植物失败（GF）是异基因造血干细胞移植（HSCT）后一种罕见但严重的并发症。由于对于逆转这种并发症的最佳策略尚无明确建议，预防移植物失败仍是最可取的方法。目前推荐用于治疗GF的方法包括给予生长因子、额外的造血祖细胞增强治疗或挽救性HSCT。GF患者很少出现无疾病复发证据的自体恢复，在没有自体恢复的情况下，在第二次预处理方案后进行进一步的挽救性移植是一种潜在的治疗选择，可提供长期无病生存的最佳机会。第二次HSCT的预处理方案对植入和结局有重大影响，然而，目前对于发生GF的患者第二次HSCT的最佳预处理方案尚无共识。此外，第二次移植是采用不同供体还是同一供体仍存在争议。
我们介绍了在管理急性白血病儿科患者干细胞移植后发生移植物失败方面的经验。
尽管第二次移植几乎是唯一的挽救方法，但我们表明，一些采用清髓性预处理（MAC）方案进行异基因干细胞移植后发生移植物失败的急性白血病儿科患者，可能通过自体造血恢复实现长期无病生存。
