Poor graft function after T cell-depleted allogeneic hematopoietic stem cell transplant

Abstract

PGF implies persistent cytopenia in the presence of predominant donor chimerism. We examined contributors to PGF in 104 HCT recipients who survived >= 100 days without relapse or major complications. Surrogate parameters for PGF were: Hg <10 g/dl, RBC transfusion dependence, platelet count <20 x 10(9)/L or ANC < 0.5 x 10(9)/L. All patients received T cell depletion with alemtuzumab or ATG. The 2-year OS and PFS probabilities were 66%, 95%CI (56 - 75%) and 51%, 95%CI (41-60%) respectively. Fifty-four patients (52%) met one or more PGF criteria. There was significant association between major ABO incompatibility and platelet <20 x 109/L (OR = 4.7, 95%CI 1.05-21.26,p = .043), acute GVHD and Hg <10 g/dl (OR 3.7, 95%CI 1.4-9.6,p = .005) and CMV viremia and ANC < 0.5 x 10(9)/L (OR 3.0, 95% CI 1.0, 8.7,p = .043). NRM was significantly higher in the PGF group compared to patients with adequate graft function (45.5% vs 16.7%,p = .014).