{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T10:43:42Z","timestamp":1747910622861},"reference-count":60,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Intramural Research Program of the NIH, NHLBI"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:p>The risk of graft\u2010rejection after allogeneic hematopoietic cell transplantation using conventional cyclophosphamide\u2010based conditioning is increased in patients with bone marrow failure syndromes (BMFS) who are heavily transfused and often HLA\u2010alloimmunized. Fifty\u2010six patients with BMFS underwent fludarabine\u2010based reduced\u2010intensity conditioning and allogeneic peripheral blood progenitor cell (PBPC) transplantation at a single institution. The conditioning regimen consisted of intravenous cyclophosphamide, fludarabine, and equine antithymocyte globulin. Graft\u2010versus\u2010host disease (GVHD) prophylaxis included cyclosporine A alone or in combination with either mycophenolate mofetil or methotrexate. To reduce the risk of graft\u2010rejection\/failure, unmanipulated G\u2010CSF mobilized PBPCs obtained from an HLA\u2010identical or single HLA\u2010antigen mismatched relative were transplanted rather than donor bone marrow. Despite a high prevalence of pretransplant HLA\u2010alloimmunization (41%) and a heavy prior transfusion burden, graft\u2010failure did not occur with all patients having sustained donor lympho\u2010hematopoietic engraftment. The cumulative incidence of grade II\u2013IV acute\u2010GVHD and chronic\u2010GVHD was 51.8% and 72%, respectively; with 87.1% surviving at a median follow\u2010up of 4.5 years. A multivariate analysis showed pretransplant alloimmunization and rapid donor T\u2010cell engraftment (\u226595% donor by day 30) were both significantly (<jats:italic>P<\/jats:italic> &lt; 0.05) associated with the development of chronic\u2010GVHD (adjusted HR 2.13 and 2.99, respectively). These data show fludarabine\u2010based PBPC transplantation overcomes the risk of graft\u2010failure in patients with BMFS, although rapid donor T\u2010cell engraftment associated with this approach appears to increase the risk of chronic\u2010GVHD. (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/Clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link> identifier: NCT00003838). Am. J. Hematol. 88:874\u2013882, 2013. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ajh.23526","type":"journal-article","created":{"date-parts":[[2013,6,27]],"date-time":"2013-06-27T15:32:53Z","timestamp":1372347173000},"page":"874-882","source":"Crossref","is-referenced-by-count":5,"title":["Rapid donor T\u2010cell engraftment increases the risk of chronic graft\u2010versus\u2010host disease following salvage allogeneic peripheral blood hematopoietic cell transplantation for bone marrow failure syndromes"],"prefix":"10.1002","volume":"88","author":[{"given":"Jeremy","family":"Pantin","sequence":"first","affiliation":[{"name":"Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services Bethesda Maryland"},{"name":"Division of Hematology, Medical Oncology and BMT Department of Medicine, Georgia Regents University  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