205 Second Allogeneic Hematopoietic Cell Transplantation for Graft Failure: Poorer Outcomes for Neutropenic Graft Failure

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Troy Christopher Lund, MD, PhD , Pediatric Blood and Marrow Transplant, University of Minnesota, Minneapolis, MN
Jessica Liegel, MD , University of Minnesota, Minneapolis, MN
Paul Orchard, MD , Pediatrics Blood and Marrow Transplantation, University of Minnesota Masonic Cancer Research Building, Minneapolis, MN
Qing Cao, MS , Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, MN
Jakub Tolar, MD, PhD , University of Minnesota, Minneapolis, MN
Claudio G. Brunstein, MD, PhD , University of Minnesota Medical Center, Minneapolis, MN
John E. Wagner, MD , Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
Michael R. Verneris, MD , Pediatric Hematology and Oncology, University of Minnesota Medical Center, Fairview, Minneapolis, MN
Daniel J. Weisdorf, MD , University of Minnesota Medical Center, Minneapolis, MN
Presentation recording not available for download or distribution as requested by the presenting author.
Graft failure (GF) after hematopoietic cell transplant (HCT) occurs in 5-30[DW1] % of patients. GF can be accompanied by neutropenia (NGF) or can result with adequate neutrophils, but loss of donor chimerism (non-neutropenic graft failure, NNGF). We analyzed the outcomes of 61 patients (pediatric and adult) treated with a second HCT for GF at the University of Minnesota; 27 with NGF and 34 with NNGF. The cumulative incidence of neutrophil engraftment at 42 days after second HCT was 88% for NNGF, and 68% for NGF (p=0.03). The incidence of grade III-IV acute graft versus host disease (GVHD) was 15% (95% confidence interval (CI), 2 – 28%) and 6% (95% CI, 2 - 17%) for NGF and NNGF, respectively (p = 0.17). From the 2ndHCT, 1-year overall survival (OS) was 54% (95% CI, 41–66%) for the entire cohort with an OS for NNGF of 73% (95% CI, 55 – 85%) and for NGF OS was 30% (95% CI, 14–47%) (p<0.01). A second GF occurred in 18 (67%) NGF and in 9 (26%) NNGF patients. Viral studies showed there was more frequent HHV6 reactivation, with 48% of the NGF group versus 8.8% of the NNGF group (p < 0.01) having reactivation. EBV and CMV reactivate was not different. The most common cause of death after second HCT was persisting GF leading to infection or infection despite engraftment. Outcomes of second HCT for NGF and NNGF are different with very poor outcomes for the NGF group, necessitating new approaches to improve overall survival.

 [DW1]Same N range as in your intro paragraph

Disclosures:
P. Orchard, Genzyme, No direct role: Honoraria and Research Funding
Biomarin, No direct role: Honoraria and Research Funding

J. E. Wagner, Novartis, Research Investigator: Research Funding
CORD:USE, Scientific Advisor: Advisory Board

D. J. Weisdorf, Alexion, Consultant, data sharing: Consultancy and Research Funding
Amgen, Consultant: Consultancy
Pharmacyclics, Consultant, study planning: Consultancy
Enlivez, Study planning: Consultancy
Therakos, Speaking/Teaching: Educational lecture
Millenium, Consultation: Consultancy
See more of: Poster Session 1: Immune Reconstitution
See more of: Poster Abstracts
<< Previous Presentation | Next Presentation >>