title: Outcome of autologous rescue after failed engraftment of allogeneic marrow.
abstract: 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.
authors.affiliation: Leukaemia Unit, Royal Marsden Hospital, Surrey, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: R
authors.initials: R
authors.lastname: Powles
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: C
authors.initials: C
authors.lastname: Horton
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
mesh_terms: 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