High incidence of secondary failure of platelet recovery after autologous and syngeneic peripheral blood stem cell transplantation in acute promyelocytic leukemia

Abstract

Secondary failure of platelet recovery (SFPR), which is a delayed decline in platelet count after primary recovery following myeloablative hematopoietic SCT, is a significant problem in allogeneic SCT. However, its clinical characteristics have not been well described in autologous SCT for acute myeloid leukemia. We reviewed 11 consecutive patients who had received autologous or syngeneic SCT for acute promyelocytic leukemia. Seven of 11 patients (64%) had SFPR, which is defined as a decline in the platelet count to less than 30 000/ll for more than 7 days. The median onset of SFPR was day 36 (range, 25-51 days) and the median duration of thrombocytopenia was 13 days (range, 4-25 days). Of nine patients who received busulfan-containing preparative regimens, seven (78%) had SFPR and one had delayed primary platelet count recovery. Neither patient who received cyclophosphamide and total body irradiation as preparative regimens had SFPR. The clinical courses of SFPR were transient and self-limited. SFPR was not associated with relapse of underlying diseases, graft failure or other fatal morbidities. The unexpectedly high prevalence and the characteristics of SFPR may provide additional information on management following autologous SCT for acute myeloid leukemia.

Phase 2 study of arsenic trioxide followed by autologous hematopoietic cell transplantation for relapsed acute promyelocytic leukemia

“…Patients who attained a target CD341 cell dose of 2.0 3 10 6 /kg or higher were allocated to undergo autologous HCT unless PML-RARa transcripts were detected in PBSCs. The conditioning regimen consisted of busulfan (1 mg/kg orally every 6 hours on days 26 to 24) and melphalan (70 mg/m 2 intravenously on days 23 to 22), 13 whereas unpurged autologous PBSCs were infused on day 0. The study flow is shown in Figure 1.…”

Fatal ongoing human cytomegalovirus reactivation during high‐dose melphalan and autologous stem cell transplantation

“…The patient described in this report also exhibited secondary failure of platelet recovery, which occurs in 8% of patients undergoing autologous transplantation (peaking at 64% in acute promyelocytic leukemia patients due to busulfan-containing regimens [Narimatsu et al, 2007]), with a median time of onset after transplantation at day þ44 (range, days 24-89), and concomitant neutropenia is seen in 19% of these patients [Bruno et al, 2001]. HCMV infection occurring after engraftment, and marrow rather than peripheral blood as the source of hematopoietic stem cells are the only significant risk factors [Nash et al, 1996].…”

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

“…26,28 Although the phenomenon has been well described among allogeneic transplant patients, very few reports are available in the literature for autologous transplant patients, more so in AML patients. 37,38 The few studies that have reported their observations on the effect of secondary thrombocytopenia on patients' survival and outcome in AML post-autologous transplantation had small numbers of AML patients in their study groups.…”

“…Also, the study by Bruno et al 27 on various malignancies reported an incidence of 19% among their autologous transplant patients. Narimatsu et al 28 from Japan reported a high incidence of secondary thrombocytopenia (64%) in their study of patients with acute promyelocytic leukemia who had autologous and syngeneic SCT. The higher incidence of secondary thrombocytopenia observed in their study might be due to the smaller sample size (7 out of 11 patients).…”

“…In addition, the phenomenon of 'secondary failure of plt recovery' or 'Idiopathic secondary post-transplant thrombocytopenia' described as a delayed decline in plt counts following an initial plt recovery, which is unassociated with either graft rejection, relapse or infection, has been reported to occur in patients who underwent hemopoietic SCT by many authors. [26][27][28] Thrombocytopenia typically occurs within the first 100 days post transplantation. Although there is availability of specific commercially prepared myeloid and erythroid growth factors for tackling posttransplant neutropenia and anemia, no such agent is yet available for the management of post-transplant thrombocytopenia.…”