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Graft Rejection After Ex Vivo T-Cell-Depleted Haploidentical Hematopoietic Cell Transplantation : Analysis of Incidence, Survival, Risk Factors, and Association With Biomarkers of Inflammation

Król, Ladislav LU orcid ; Wichert, Stina LU orcid ; Tomaszewska-Toporska, Beata ; Lenhoff, Stig ; Pronk, Cornelis Jan ; Toporski, Jacek LU ; Øra, Ingrid LU orcid ; Dykes, Josefina LU and Turkiewicz, Dominik LU (2025) In Transplantation Proceedings 57(6). p.1143-1152
Abstract

Background: Graft rejection (GR) is common complication after haploidentical hematopoietic cell transplantation (haplo-HCT). There are only a few studies describing the clinical presentation and potential risk factors of GR, and the optimal rescue strategy is not established. Objectives: To evaluate the cumulative incidence and potential risk factors for GR following haplo-HCT, and to compare survival, clinical symptoms, selected inflammatory parameters, and lactate dehydrogenase levels in patients with and without GR. Methods: A retrospective single-center study including 79 patients (59 children and 20 adults) who underwent ex vivo T-cell-depleted haplo-HCT at Skåne University Hospital from 2001 to 2020. Results: The cumulative... (More)

Background: Graft rejection (GR) is common complication after haploidentical hematopoietic cell transplantation (haplo-HCT). There are only a few studies describing the clinical presentation and potential risk factors of GR, and the optimal rescue strategy is not established. Objectives: To evaluate the cumulative incidence and potential risk factors for GR following haplo-HCT, and to compare survival, clinical symptoms, selected inflammatory parameters, and lactate dehydrogenase levels in patients with and without GR. Methods: A retrospective single-center study including 79 patients (59 children and 20 adults) who underwent ex vivo T-cell-depleted haplo-HCT at Skåne University Hospital from 2001 to 2020. Results: The cumulative incidence of GR was 14.8% (95% CI: 7.1-22.6). The median time to GR was 21 days (13-31). Five-year overall survival for patients without GR was 45.3% (95% CI: 32.8-57.7), and 41.7% (95% CI: 13.8-69.9) for those with GR (P = n.s.). None of the analyzed patient- and transplant-related factors were significantly associated with GR. Macular rash was the only GR-associated symptom. Patients with GR had higher median ferritin (18,096 µg/L; 1412-95,980) and lactate dehydrogenase (10.5 µkat/L, 0.7-35.0), and lower fibrinogen (2.65 g/L; 0.9-3.9) levels then patients who engrafted. Conclusions: In our cohort, GR was not associated with inferior survival and prompt retransplantation seems to be an effective rescue strategy. GR is characterized by increased levels of inflammation markers, while clinical symptoms are nonspecific. Further analysis in a larger cohort is necessary to assess whether regular monitoring of inflammatory parameters could guide preemptive treatment strategies for GR.

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organization
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type
Contribution to journal
publication status
published
subject
in
Transplantation Proceedings
volume
57
issue
6
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:105009250555
  • pmid:40582934
ISSN
0041-1345
DOI
10.1016/j.transproceed.2025.05.025
language
English
LU publication?
yes
id
1934b80a-f740-4774-9e84-e6ffc305f66a
date added to LUP
2025-12-12 12:49:17
date last changed
2025-12-12 12:50:41
@article{1934b80a-f740-4774-9e84-e6ffc305f66a,
  abstract     = {{<p>Background: Graft rejection (GR) is common complication after haploidentical hematopoietic cell transplantation (haplo-HCT). There are only a few studies describing the clinical presentation and potential risk factors of GR, and the optimal rescue strategy is not established. Objectives: To evaluate the cumulative incidence and potential risk factors for GR following haplo-HCT, and to compare survival, clinical symptoms, selected inflammatory parameters, and lactate dehydrogenase levels in patients with and without GR. Methods: A retrospective single-center study including 79 patients (59 children and 20 adults) who underwent ex vivo T-cell-depleted haplo-HCT at Skåne University Hospital from 2001 to 2020. Results: The cumulative incidence of GR was 14.8% (95% CI: 7.1-22.6). The median time to GR was 21 days (13-31). Five-year overall survival for patients without GR was 45.3% (95% CI: 32.8-57.7), and 41.7% (95% CI: 13.8-69.9) for those with GR (P = n.s.). None of the analyzed patient- and transplant-related factors were significantly associated with GR. Macular rash was the only GR-associated symptom. Patients with GR had higher median ferritin (18,096 µg/L; 1412-95,980) and lactate dehydrogenase (10.5 µkat/L, 0.7-35.0), and lower fibrinogen (2.65 g/L; 0.9-3.9) levels then patients who engrafted. Conclusions: In our cohort, GR was not associated with inferior survival and prompt retransplantation seems to be an effective rescue strategy. GR is characterized by increased levels of inflammation markers, while clinical symptoms are nonspecific. Further analysis in a larger cohort is necessary to assess whether regular monitoring of inflammatory parameters could guide preemptive treatment strategies for GR.</p>}},
  author       = {{Król, Ladislav and Wichert, Stina and Tomaszewska-Toporska, Beata and Lenhoff, Stig and Pronk, Cornelis Jan and Toporski, Jacek and Øra, Ingrid and Dykes, Josefina and Turkiewicz, Dominik}},
  issn         = {{0041-1345}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1143--1152}},
  publisher    = {{Elsevier}},
  series       = {{Transplantation Proceedings}},
  title        = {{Graft Rejection After Ex Vivo T-Cell-Depleted Haploidentical Hematopoietic Cell Transplantation : Analysis of Incidence, Survival, Risk Factors, and Association With Biomarkers of Inflammation}},
  url          = {{http://dx.doi.org/10.1016/j.transproceed.2025.05.025}},
  doi          = {{10.1016/j.transproceed.2025.05.025}},
  volume       = {{57}},
  year         = {{2025}},
}