Graft failure

The failure to establish hematopoiesis after hematopoietic stem cell transplantation (HSCT) is a devastating complication that can occur during both autologous and allogeneic stem cell transplant. Early graft failure carries a poor prognosis; patients who develop late graft failure generally do slightly better. Numerous factors are known to increase the risk of engraftment failure; and working to reduce the risk upfront to minimize this tragic complication is vital, as despite improvements in supportive care the mortality associated with primary engraftment failure remains very high. In the setting of autologous stem cell transplant, newer agents to enhance mobilization of stem cells and recognition of clear minimum stem cell doses required to proceed with the procedure have minimized the risks of graft failure as best as possible.