Treatment of donor graft failure with nonmyeloablative conditioning of fludarabine, antithymocyte globulin and a second allogeneic hematopoietic transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 5; pp. 431 - 435
• Main Authors: JABBOUR, E, RONDON, G, ANDERLINI, P, GIRALT, S. A, COURIEL, D. R, CHAMPLIN, R. E, KHOURI, I. F
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-09-2007
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antilymphocyte serum; Antilymphocyte Serum - administration & dosage; Antithymocyte globulin; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Conditioning; Cord blood; Disease prevention; Dosage and administration; Drug therapy; Failure; Feasibility Studies; Female; Fludarabine; Globulins; Graft Rejection; Graft Survival; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - drug therapy; Graft vs Host Disease - prevention & control; Grafting; Grafts; Hematopoiesis; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humans; Male; Medical sciences; Middle Aged; Patients; Physiological aspects; Pilot Projects; Prophylaxis; Risk factors; Salvage Therapy - methods; Stem cell transplantation; Stem cells; Tacrolimus; Tacrolimus - therapeutic use; Thymocytes; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Transplantation, Autologous; Transplants & implants; Vidarabine - administration & dosage; Vidarabine - analogs & derivatives; United States; Antineoplastic agent; Purine nucleotide; Hematology; Homograft; Non myeloablative treatment; second transplant; Graft failure; Second transplantation; Fludarabine; Treatment; Antimetabolic; Immunotherapy; Graft; Myelosuppression; Fluorine Organic compounds; Antithymocyte globulin; non-ablative conditioning
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705760

Graft failure is a life-threatening complication of allogeneic stem cell transplantation (SCT). We assessed the feasibility of performing a second SCT after such failure when fludarabine and antithymocyte globulin (ATG) are used for non-myeloablative conditioning and tacrolimus for graft-versus-host disease (GVHD) prophylaxis. Nine patients with SCTs for various hematologic malignancies were enrolled, eight with primary and one with secondary graft failure. The median time between the first and second SCT was 53 days. Eight patients had the same donor for their second SCT, and one had a cord blood transplant. Three patients were not evaluable because of early death; the other six had evidence of donor cell engraftment. Six of the nine patients developed acute grade II-IV GVHD, the main cause of death. Overall, we found that fludarabine and ATG conditioning before a second SCT allows engraftment of donor hematopoiesis. Future studies should include more intense GVHD prophylaxis.