Outcome of autologous rescue after failed engraftment of allogeneic marrow.
Ten patients experiencing primary graft failure after allogeneic bone marrow transplantation received autologous marrow or blood cells as hematopoietic rescue 21-40 (median 22.5) days after the original transplant after which immunosuppression with cyclosporine was tapered off rapidly. The leukocyte count at the time of rescue was 0.1-0.3 x 10(9)/l with < 0.1 x 10(9)/l neutrophils. The clinical course was uneventful after rescue with hematologic recovery to 0.5 x 10(9)/l neutrophils occurring 9-61 days (median 20) later in nine patients, and to 50 x 10(9)/l platelets 17-595 days (median 40) later in eight patients. No patient had a life-threatening infection at the time of or after rescue. No patient experienced acute graft-versus-host disease. Four patients with acute leukemia had recurrent disease 46-117 days after autologous rescue, and died of relapse. Five patients with acute leukemia are alive in continuous remission at 270-3382 days, and one patient with chronic myeloid leukemia is alive in hematologic remission at 228 days. We conclude that infusion of back-up autologous cells can prevent the immediate infectious consequences of primary allogeneic graft failure through consistent myeloid recovery, and may result in long-term survival of patients with good-risk disease.
Mehta
J
J
Leukaemia Unit, Royal Marsden Hospital, Surrey, UK.
Powles
R
R
Singhal
S
S
Horton
C
C
Treleaven
J
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006085:Graft Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007239:Infections / Q000453:epidemiology; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D007951:Leukemia, Myeloid / Q000401:mortality / Q000628:therapy; D008297:Male; D009503:Neutropenia / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome