title: Recovery from neutropenia can be predicted by the immature reticulocyte fraction several days before neutrophil recovery in autologous stem cell transplant recipients.
abstract: The duration of neutropenia (absolute neutrophil count (ANC) < or = 100/microl) identifies cancer patients at risk for infection. A test that precedes ANC > or = 100/microl would be of clinical value. The immature reticulocyte fraction (IRF) reflects erythroid engraftment and hence a recovering marrow. We evaluated the IRF as predictor of marrow recovery among 90 myeloma patients undergoing their first and second (75 patients) melphalan-based autologous stem cell transplantation (Mel-ASCT). The time to IRF doubling (IRF-D) preceded ANC > or = 100/microl in 99% of patients after the first Mel-ASCT by (mean+/-s.d.) 4.23+/-1.96 days and in 97% of the patients after the second Mel-ASCT by 4.11+/-1.95 days. We validated these findings in a group of 117 myeloma patients and 99 patients with various disorders undergoing ASCT with different conditioning regimens. We also compared the time to hypophosphatemia and to absolute monocyte count > or = 100/microl to the time to ANC > or = 100/microl. These markers were reached prior to this ANC end point in 55 and 25% of patients but were almost always preceded by IRF-D. We conclude that the IRF-D is a simple, inexpensive and widely available test that can predict marrow recovery several days before ANC> or = 100/microl.
authors.affiliation: Myeloma Institute of Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Grazziutti
authors.forename: L
authors.initials: L
authors.lastname: Dong
authors.forename: M H
authors.initials: MH
authors.lastname: Miceli
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: S G
authors.initials: SG
authors.lastname: Krishna
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: F
authors.initials: F
authors.lastname: van Rhee
authors.forename: B M
authors.initials: BM
authors.lastname: Barlogie
authors.forename: E J
authors.initials: EJ
authors.lastname: Anaissie
mesh_terms: D015331:Cohort Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007700:Kinetics; D009101:Multiple Myeloma / Q000175:diagnosis / Q000628:therapy*; D009503:Neutropenia / Q000628:therapy*; D009504:Neutrophils / Q000473:pathology*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D017701:Reticulocyte Count / Q000379:methods*; D012189:Retrospective Studies; D014182:Transplantation, Autologous