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Suma S, Yokoyama Y, Momose H, Makishima K, Kiyoki Y, Sakamoto T, Kusakabe M, Kato T, Kurita N, Nishikii H, Sakata-Yanagimoto M, Obara N, Hasegawa Y, Chiba S. Salvage Cord Blood Transplantation Using a Short-term Reduced-intensity Conditioning Regimen for Graft Failure. Intern Med 2022; 61:1673-1679. [PMID: 34803091 PMCID: PMC9259308 DOI: 10.2169/internalmedicine.7836-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Graft failure (GF) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT). A standardized conditioning regimen and an appropriate graft source of salvage HSCT for GF have not yet been established. Some case series have shown good hematopoietic recoveries after salvage HSCT using a short-term reduced-intensity preparative regimen consisting of fludarabine (30-90 mg/m2), cyclophosphamide (2 g/m2), and total-body irradiation (2 Gy). However, the dose of fludarabine has varied in these reports based on the clinical condition of the patients, resulting in very limited experiences with each dose of fludarabine. Methods We retrospectively analyzed 10 patients who developed GF after allogeneic HSCT and underwent salvage cord blood transplantation (CBT) using the above-mentioned conditioning regimen with a fixed dose (90 mg/m2) of fludarabine. Results Eight patients (80.0%) achieved neutrophil engraftment within 30 days from salvage HSCT with a median of 21 (range, 17-23) days. The 1-year overall survival (OS) rate after the salvage HSCT was 50.0%, and the median OS was 281 (range, 23-1,638) days. Cumulative incidences of non-relapse mortality and relapse at 1 year were 50.0% and 10.0%, respectively. Conclusion CBT using this short-term reduced-intensity conditioning regimen may be a promising salvage therapy for GF.
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Affiliation(s)
- Sakurako Suma
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Yasuhisa Yokoyama
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Haruka Momose
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Kenichi Makishima
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Yusuke Kiyoki
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Tatsuhiro Sakamoto
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Manabu Kusakabe
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Takayasu Kato
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Naoki Kurita
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Hidekazu Nishikii
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Mamiko Sakata-Yanagimoto
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Naoshi Obara
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
| | - Yuichi Hasegawa
- Department of Hematology, Ibaraki Prefecture Central Hospital, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Hematology, University of Tsukuba Hospital, Japan
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