Factors influencing haematological recovery in 53 patients with acute myeloid leukaemia in first remission after autologous bone marrow transplantation

Abstract

The kinetics of haematological recovery were retrospectively analysed in 53 patients with acute myeloid leukaemia in first remission after myeloablative chemoradiotherapy followed by autologous bone marrow transplantation. The median time to achieve a neutrophil count of 1 x 10(9)/l was 46 d (22-196 d) and median time to achieve unsupported platelet counts of 20 x 10(9)/l and 50 x 10(9)/l was 70 d (24-310 d) and 126 d (29-497 d) respectively. Multivariate analysis revealed two factors that were significantly associated with delayed neutrophil and platelet recovery: (1) use of high dose fractionated TBI and mononuclear cell cryopreservation, and (2) low platelet count at the time of bone marrow harvest. There was no correlation with: number of courses of chemotherapy, remission to ABMT interval, CMV status, indices of autograft quality or the development of elevated platelet associated immunoglobulin. Delayed haematological recovery did not predict for relapse or death. Delayed platelet recovery did, however, present significant problems with increased blood and platelet requirements and lengthening of hospital stay.

Prolonged isolated thrombocytopenia after hematopoietic stem cell transplantation: morphologic correlation

“…9 In previous studies relating to the pathogenesis of prolonged isolated thrombocytopenia, bone marrow biopsy findings have been incompletely evaluated or reported. [5][6][7]10 In order to understand better mechanistically whether lack of production or peripheral destruction of platelets is the cause of prolonged isolated thrombocytopenia, we undertook a more detailed evaluation of bone marrow biopsies from affected patients. We report here the evaluation of pre-and post-transplant bone marrow biopsies from patients with prolonged isolated thrombocytopenia for overall cellularity, megakaryocyte number, and megakaryocyte abnormalities to determine factors which correlate with prolonged isolated thrombocytopenia.…”

Histological alterations in bone marrow in patients with late engraftment after autologous bone marrow transplantation

“…3,21 However, autografted AML patients are excellent subjects for histological BM investigations since they account for the majority of delayed engraftments and the contribution of extramedullary components to the timing of engraftment is minimal. [15][16][17][18] Moreover, leukemic relapse cannot be ruled out in patients failing to achieve normal peripheral values, and so BMB may help in differentiating this diagnosis from truly delayed engraftment. 15,22 On the basis of the above considerations, the present series includes only the AML patients who underwent autografting at our center during the last 10 years.…”

“…[15][16][17][18] Moreover, leukemic relapse cannot be ruled out in patients failing to achieve normal peripheral values, and so BMB may help in differentiating this diagnosis from truly delayed engraftment. 15,22 On the basis of the above considerations, the present series includes only the AML patients who underwent autografting at our center during the last 10 years. The patients with normal and those with delayed peripheral recovery were fully comparable in terms of previous treatment, disease phase, conditioning regimen and the number of infused cells.…”

“…[11][12][13][14] Most of the cases in this group are acute myelogenous leukemia (AML) patients, who are neither routinely transplanted with peripheral stem cells nor treated with growth factors. [15][16][17][18] Harvesting insufficiencies, and microenvironmental derangement due to previous conventional chemotherapy and conditioning regimens, are the main causes of delayed peripheral recovery. 2,[19][20][21][22] Bone marrow biopsies (BMB) allow a good assessment of cellularity and reticulin, but are not frequently performed during late engraftment, and the results observed in the small series studied so far have been inconclusive.…”

Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome

“…10 The pattern of engraftment and hemopoietic recovery following AHSCT has been extensively studied in patients with AML. 11,12 Following the myeloablative conditioning, which is used in autologous transplantation in AML patients, the time taken for the restoration of hemopoietic activity as measured by the presence of adequate number of blood cells is known to follow a predictable pattern within the first month post transplantation, usually first with an increase in the number of granulocytes followed by plts and lymphocytes, and finally the RBCs. 13 Several factors have been associated with the delay in the recovery time of the cell lines, such as the source of stem cells, dose of stem cells infused, disease status at transplant and infections, especially by CMV, and many studies have reported a poorer outcome in the OS of patients with delayed engraftment.…”