Morphologic examination of sequential bone marrow biopsies after nonmyeloablative stem cell transplantation complements molecular studies of donor engraftment.
BACKGROUND
Nonmyeloablative stem cell transplantation (NMSCT) is a mode of immunotherapy increasingly employed in treating hematologic, lymphoid, and solid tumors. Patients are monitored principally by molecular analysis of donor engraftment.


OBJECTIVE
To determine the role of morphologic examination of bone marrow after NMSCT.


METHODS
Seventy-three patients undergoing NMSCT under the Campath 1H (humanized anti-CD52 antibody) protocol were studied. Pretransplant and sequential posttransplant bone marrow specimens were evaluated and the findings were correlated with corresponding engraftment data.


RESULTS
Pretransplant bone marrow specimens from 43% of the patients were involved by disease, and these marrow specimens were significantly more cellular than those that were free of disease. Morphologically detectable disease was still present in day 14 posttransplant marrow specimens in more than one half of these patients, but there was no difference in engraftment in those with or without marrow disease. Early posttransplant marrow in nearly one half of the patients showed myeloid hyperplasia and atypical localization of immature myeloid precursors. Marrow cellularity for the first 2 months after NMSCT was significantly lower in those patients receiving stem cells mismatched at 1 to 3 loci as compared with those who received fully matched grafts (mean cellularity, 38.1% vs 54.1% at day 14). Marrow failure without recurrent disease at 3 to 6 months after transplant was detected by engraftment study in only approximately 15% of cases. Similarly, early recurrence of disease was detected first by morphologic examination in 4 of 13 cases before a decline in donor engraftment occurred.


CONCLUSIONS
Morphologic examination of bone marrow provides additional information that is complementary to donor engraftment analysis for optimal management after NMSCT.
Lagoo
Anand S
AS
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA. anand.lagoo@duke.edu
Gong
Jerald Z
JZ
Stenzel
Timothy T
TT
Goodman
Barbara K
BK
Buckley
Patrick J
PJ
Chao
Nelson J
NJ
Gasparetto
Cristina
C
Long
Gwynn D
GD
Rizzieri
David A
DA
D000328:Adult; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D006085:Graft Survival / Q000235:genetics*; D019337:Hematologic Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D011300:Preoperative Care; D033581:Stem Cell Transplantation; D013997:Time Factors; D014019:Tissue Donors