Salvage with a mini-allograft after primary engraftment failure following autologous transplant for multiple myeloma

Haploidentical allogeneic haematopoietic stem cell transplantation as salvage therapy for engraftment failure after unrelated and autologous stem cell transplantation: a case report and review of the literature

Engraftment failure is a rare but life-threatening complication of haematopoietic stem cell transplantation (HSCT) and treatment of this condition is often challenging. This case report describes a patient with acute myeloid leukaemia and engraftment failure after unrelated donor allogeneic stem cell transplantation. Rescue treatment with granulocyte-colony stimulating factor and reinfusion of autologous 'back-up' stem cells failed, but transplantation of haploidentical donor stem cells following a fludarabine and antithymocyte globulin (ATG)-based conditioning regimen resulted in haematological reconstitution and long-term disease-free survival. The use of haploidentical donor stem cell transplantation as salvage therapy after engraftment failure in adult patients has not, to the authors' knowledge, been previously reported. Additionally, a review of the relevant literature is presented. This case report and literature review suggest that reinfusion of cryopreserved 'back-up' haematopoietic stem cells is a safe and effective salvage therapy for engraftment failure after allogeneic HSCT. Haploidentical donor stem cell transplantation after a fludarabine and ATG-based conditioning regimen could provide effective second-line therapy in adult patients.

Unrelated umbilical cord blood transplantation as salvage treatment for engraftment failure following autologous stem cell transplantation

We report a case of a patient with multiple myeloma and engraftment failure after high-dose therapy with autologous stem cell transplantation. After rescue treatment with G-CSF and back-up reinfusion of autologous stem cells failed, allogeneic umbilical cord blood transplantation resulted in neutrophil engraftment on day +16 and a 57 months lasting complete remission. This case report shows that umbilical cord blood transplantation is a rescue option after engraftment failure of autologous transplantation, which is available for 99% of patients due to the less stringent HLA matching criteria. Moreover, the prompt availability allows transplantation to be performed at an optimal time.