Second Transplant for Primary Graft Failure after Haematopoietic Stem Cell Transplant

Abstract

<h3>Introduction</h3> Primary graft failure after hematopoietic stem cell transplantation (HSCT) is a life threatening complication. The incidence is reported to be as high as 11%. It is very challenging as the patient is high risk having been pancytopenic for weeks, may have active infections and a poor performance status. There is also tremendous financial and emotional burden on the family. Here, we describe the results of 12 patients that received a second rescue transplant for primary graft failure. <h3>Aim</h3> To assess the incidence of primary graft failure and the outcome of second rescue transplant. <h3>Methods</h3> A total of 721 Allogenic transplants were performed between 2010-2019 at our centre; 14(1.94%) had primary graft failure. Out of these 12 that failed to engraft or had autologous reconstitution underwent a second rescue transplant. The patient and transplant characteristics are given in Table 1. <h3>Results</h3> Out of 12 second transplant; 9 patients achieved neutrophilic engraftment. The median neutrophil and platelet engraftment was 14(range 9-24) and 19(9-34) days. Two patients had Acute and 3 developed chronic GvHD (one limited and two extensive). CMV reactivation was seen in 4 patients. Seven out of 12 (58%) patients expired (Gram negative sepsis in 6 and chronic liver GvHD in one). At a median follow up of 190 days (-1 to 3003); 42% of patients are alive and disease free. <h3>Conclusion</h3> Outcome of primary graft failure is dismal. A second rescue transplant in our study showed a successful engraftment and long term survival of 42%. Thus a second transplant should be attempted as a life saving measure.