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Graft failure after T-cell-depleted human leukocyte antigen identical
marrow transplants for leukemia: I. Analysis of risk factors and results of
secondary transplants
NA Kernan, C Bordignon, G Heller, I Cunningham, H Castro-Malaspina, B Shank, N Flomenberg, J Burns, SY Yang and P Black
Charles A. Dana Marrow Transplant Unit, Memorial Sloan-Kettering Cancer
Center, New York, NY 10021.
Risk factors for graft failure were analyzed in 122 recipients of an
allogeneic T-cell-depleted human leukocyte antigen (HLA)-identical sibling
marrow transplant as treatment for leukemia. In each case pretransplant
immunosuppression included 1,375 to 1,500 cGy hyperfractionated total body
irradiation and cyclophosphamide (60 mg/kg/d x 2). No patient received
immunosuppression prosttransplant for graft-versus-host disease (GVHD)
prophylaxis. Nineteen patients in this group experienced graft failure. The
major factors associated with graft failure were transplants from male
donors and the age of the patient (or donor). Among male recipients of male
donor-derived grafts a low dose per kilogram of nucleated cells, progenitor
cells (colony forming unit-GM) and T cells was also associated with graft
failure. Additional irradiation to 1,500 cGy, high dose corticosteroids
posttransplant, and additional peripheral blood donor T cells did not
decrease the incidence of graft failure. In addition, type of leukemia,
time from diagnosis to transplant, an intact spleen, or the presence of
antidonor leukocyte antibodies did not correlate with graft failure. To
ensure engraftment of secondary transplants, further immunosuppression was
necessary but was poorly tolerated. However, engraftment and survival could
be achieved with an immunosuppressive regimen in which antithymocyte
globulin and high dose methylprednisolone were administered both before and
after infusions of secondary partially T- cell-depleted marrow grafts.
Volume 74,
Issue 6,
pp. 2227-2236,
11/01/1989
Copyright © 1989 by The American Society of Hematology
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