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EBMT 2025 | Exploring determinants and outcomes of graft failure in pediatric SCT for non-malignant disorders
Rawad Rihani, MD, MSc, King Hussein Cancer Center, Amman, Jordan, discusses the findings of a comprehensive analysis exploring the determinants and outcomes of graft failure in pediatric patients undergoing stem cell transplantation (SCT) for non-malignant disorders. Dr Rihani reveals that 26% of patients experienced secondary graft failure and discusses the factors found to be significant predictors. Dr Rihani highlights the importance of refining transplant conditioning regimens and donor and recipient selection to improve outcomes for these patients. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
We retrospectively reviewed the transplants in pediatric non-malignant conditions. There were about 1,246 patients who received a transplant, and among those, there were 529 who received a transplant for non-malignant disorders. And for those who looked at the determinants of graft failure in these patients, and we found about 26% of those patients developing secondary graft failure...
We retrospectively reviewed the transplants in pediatric non-malignant conditions. There were about 1,246 patients who received a transplant, and among those, there were 529 who received a transplant for non-malignant disorders. And for those who looked at the determinants of graft failure in these patients, and we found about 26% of those patients developing secondary graft failure.
This is a retrospective review that we conducted between 2002 and June 2024, and we used univariate and multivariate analysis to determine those determinants of graft failure. And mainly we found that the type of transplant, the type of conditioning, is very important. For example, the use of reduced-intensity transplants was associated more with graft failure, and also those transplants that received no conditioning, such as immune deficiencies.
We looked at the stem cell type and the stem cell type was also one of the predictors of graft failure, so those patients who received peripheral blood and cord blood stem cells were associated more in our group with graft failure in non-malignant conditions. And also, we looked at the stem cell dose, but it was not one of the predicting factors.
Those patients who developed graft failure had more hospitalizations and higher rates of mortality. But this needs to be examined in a prospective review. However, this study will help us refine our transplant conditioning regimens and also improve the selection of the donor and the recipient, as gender mismatch, which in our study was found to be one of the predictors also of graft failure. And this will hopefully improve the outcome of those transplants.
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