Time of Post Transplant Complications
The first 100 days following the cell infusion is typically the time of greatest risk for post transplant complications of autologous and allogeneic stem cell transplant. Care by physicians skilled in the management of patients undergoing these procedures is of critical importance. Progress in the supportive care of patients is critically important in improving overall outcomes.
Graft failure Post Transplant
Graft failure is defined as the lack of hematopoietic cell engraftment following autologous and allogeneic stem cell transplant. Criteria are predominantly operational and graft failure is divided into primary (early) and secondary (late) phases. The consequences of graft failure are significant and include a high risk of mortality, often as a consequence of infection and hemorrhage related to cytopenias.
Graft rejection Post Transplant
Graft rejection is a term that is unique to allogeneic stem cell transplant. It is the immune-mediated rejection of the donor cells by residual host effector cells that occurs because of the genetic disparity between the recipient and the donor.
Graft rejection is a possible cause of primary or secondary graft failure following allogeneic stem cell transplant. The determination of graft rejection requires analysis of blood or marrow for chimerism as graft rejection is defined as the inability to detect a meaningful percentage of donor hematopoietic elements. In contrast to graft rejection, poor graft function describes the failure to achieve adequate blood counts following allogeneic stem cell transplant in the presence of complete donor hematopoietic cell chimerism.
Incidence of graft failure post transplant
The incidence of graft failure varies widely in published reports as often the consequences associated with graft failure (i.e., morbidity and mortality caused by infection, hemorrhage, and disease progression) are reported and not the graft failure itself. To estimate the incidence of graft failure following autologous stem cell transplant it is reasonable to consider that in most centers the 100- day nonrelapse mortality is 10 percent or less, of which only a small subset can be attributed to graft failure.