Primary poor graft function (
PGF) is a severe complication after allogeneic
stem cell transplantation (SCT). The incidence, risk factors, and outcomes of
PGF have not been well described, especially in the haploidentical SCT setting. We retrospectively reviewed patients who received haploidentical SCT at Peking University Institute of Hematology between January 1, 2011, and December 31, 2012.
PGF was defined as persistent
neutropenia (≤0.5 × 10(9) L(-1)),
thrombocytopenia (platelets ≤20 × 10(9) L(-1)), and/or
hemoglobin ≤70 g L(-1) after engraftment with hypocellular bone marrow and full donor chimerism, without concurrent
graft-versus-host disease or disease relapse. Incidence was calculated from all patients. Of the 464 total patients, 26 (5.6 %) developed primary
PGF. The risk factors were analyzed and compared with control patients with good graft function who were selected using the case-pair method. Finally, 104 patients were selected as a control group according to the matching conditions: (1) the type (acute
leukemia,
myelodysplastic syndrome (MDS),
chronic myelogenous leukemia (CML)) and status (standard risk, high risk) of underlying disease, (2) sex, (3) year in which the
transplantation was received, and (4) a 1:4 ratio of case-control. No factors were found to be associated with primary
PGF. Compared to cases with good graft function, patients with primary
PGF experienced poor overall survival (34.6 vs. 82.7 %, p < 0.001). Of the 26 primary
PGF patients, only nine achieved hematopoietic recovery and survived. In conclusion, primary
PGF is a rare but life-threatening complication after haploidentical SCT, and effective
therapies need to be explored.