Review outlines mechanisms and management for poor graft function

A review published in Annals of Hematology examines the complex clinical and biological factors underlying poor graft function, a serious complication following allogeneic hematopoietic cell transplantation. The study, authored by Merve Pamukçuoğlu and Mehmet Sezgin Pepeler, characterizes the condition by persistent cytopenias despite donor engraftment, noting its association with substantial morbidity and inferior survival. The authors argue that the clinical interpretation of this condition remains challenging due to significant heterogeneity in diagnostic criteria and the frequent overlap with other post-transplant complications such as graft failure, graft rejection, mixed chimerism, relapse, infection, and treatment-related marrow suppression.

The review proposes that poor graft function may result from a complex interplay among several distinct biological mechanisms. These include stem cell-intrinsic defects, injury to the bone marrow microenvironment, inflammatory and immune dysregulation, viral reactivation, and the presence of donor-specific antibodies. By synthesizing current evidence, the authors suggest that these mechanisms provide a biologic framework for contemporary management strategies.

Therapeutic approaches discussed in the article range from standard supportive care and the correction of reversible causes to more specialized cellular therapies. The review highlights the use of thrombopoietin receptor agonists and mesenchymal stem cell-based or niche-directed strategies as part of the management landscape. A specific focus is placed on CD34+ -selected stem cell boost, which is described as an important cellular therapeutic option for patients with persistent poor graft function.

Clinical considerations regarding the safety of stem cell boosts are also detailed. The review notes that active infection at the time of stem cell boost has been associated with treatment failure and inferior outcomes, suggesting that infection control is a critical prerequisite for this intervention. Furthermore, the presence of donor-specific antibodies is identified as a potential additional alloimmune barrier to hematopoietic recovery in selected transplant settings.

The authors conclude by summarizing the current state of definitions, pathophysiologic mechanisms, diagnostic considerations, and therapeutic strategies in poor graft function. They highlight the need for future directions in biomarker development and standardized reporting to improve the consistency of clinical data. The review highlights future directions for biomarker development, standardized reporting, and mechanism-based management.

Subject of Research: Mechanisms and management of poor graft function after allogeneic hematopoietic cell transplantation

Article Title: Poor graft function after allogeneic hematopoietic cell transplantation: From definition to mechanism-based management

Article References: Pamukçuoğlu, M., & Pepeler, M. S. (2026). Poor graft function after allogeneic hematopoietic cell transplantation: From definition to mechanism-based management. Annals of Hematology. https://doi.org/10.1007/s00277-026-07315-3

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DOI: 10.1007/s00277-026-07315-3

Keywords: poor graft function, allogeneic hematopoietic cell transplantation, cytopenias, stem cell boost, donor-specific antibodies, bone marrow microenvironment, hematology, review, Poor, graft, function, allogeneic