Onishi Y, et al. - A research was undertaken to appraise the outcome of second transplantation using umbilical cord blood for graft failure (GF) after allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia. The umbilical cord blood could be an effective and promising option for stem cell source for urgent second transplantation in patients with aplastic anemia who developed GF after the previous HSCT. However, further investigation was needed.

• Experts investigated the outcome of 22 patients with aplastic anemia, aged ≥16 years, who underwent umbilical cord blood transplantation for GF after the first HSCT, using the registry database of the Japan Society for Hematopoietic Cell Transplantation.
• They indicated that the median age of patients was 36 years (range, 16–72).
• In addition, the median time from the first to the second transplant was 77 days (range, 29–1061).
• 45.5% was the cumulative incidence of neutrophil engraftment at day 60 post-transplant (95% confidence interval [CI]: 23.6%–65.0%).
• The 4-year overall survival (OS) was 38.5% (95% CI: 18.4%–58.5%), with a median follow-up of 50 months.
• As compared to the other group of calcineurin inhibitor alone or methotrexate-based prophylaxis, mycofenolate mofetil-based graft-versus-host disease prophylaxis demonstrated a higher neutrophil recovery (66.7% vs. 37.5%, P = 0.04).
• In comparison to other regimens, the use of conditioning regimens, such as fludarabine + melphalan or cyclophosphamide + low-dose total body irradiation, tended to demonstrate higher engraftment (58.3% vs. 30%, P = 0.05) and better 4-year OS (55.6% vs. 20%, P = 0.05).