Failure of trilineage blood cell reconstitution after initial neutrophil engraftment in patients undergoing allogeneic hematopoietic cell transplantation – frequency and outcomes

Abstract

Summary:The outcomes of patients who experience the failure to reconstitute a trilineage of blood cells after initial neutrophil engraftment were evaluated in 178 patients with hematologic disorders, who underwent allogeneic HCT. Of 165 qualified patients (five with primary engraftment failure; eight deaths before day 60 of HCT), 43 (26%) satisfied the criteria for the initial (n ¼ 22; failure of platelet 420 000/ll or red blood cell transfusion independence/reticulocyte count X1.0% by day 60) or subsequent (n ¼ 21, ANC o500/ll for X3 days, platelet o20 000/ll for X7 days, or red blood cells transfusion/reticulocyte o1.0% after initial trilineage reconstitution) failure. GVHD was the most common clinical condition associated with cytopenia (n ¼ 24). In all, 20 patients (47%) recovered at least partially with a median of 52 days (range 8-323) later, with 12 of those 20 patients recovering completely. The eventual reconstitution failure rate was 14% (23/163 patients). The number of cell lineages involved in the cytopenia was the only independent variable that predicted partial recovery (1 lineage vs 2-3 lineages with odds ratio of 8.69 (95% CI 1.96-38.60), P ¼ 0.004). Five/20 patients with vs 20/23 patients without partial recovery died. Trilineage reconstitution failures after allogeneic HCT need systematic analysis in the future studies.

The incidence, risk factors, and outcomes of primary poor graft function after unmanipulated haploidentical stem cell transplantation

“…Early reports found that the incidence of PGF ranged from 5 to 27 % [3,11]; however, there were a number of flaws with these studies, including a lack of distinction between PGF and graft rejection, as well as a lack of separation between cases of primary and secondary PGF. It is important to distinguish between these two types of PGF because we now realize that primary and secondary PGF are distinct entities with significantly different prognoses [4] and the majority of cases are actually secondary PGF.…”

Mitochondrial Reactive Oxygen Species Regulate Adipocyte Differentiation of Mesenchymal Stem Cells in Hematopoietic Stress Induced by Arabinosylcytosine

“…Nevertheless, delayed hematopoietic recovery and related complications, including infection, anemia, and hemorrhage, occur in a considerable number of patients and seriously affect patient survival [1]. The reasons and mechanisms of delayed hematopoietic recovery are still not clear.…”

Concise Review: The Bone Marrow Niche as a Target of Graft Versus Host Disease

“…Nonlymphoid cytopenia also frequently occurs after HSCT and has been described in the context of infections (e.g., cytomegalovirus), relapse and graft‐failure, or pharmacological induction . In particular, thrombocytopenia has been observed to associate with acute and chronic GvHD . Notably, in a multivariate analysis, acute GvHD was described as one of the factors that associated significantly with the secondary failure of platelet recovery (SFPR) .…”

“…This association was highlighted by the concomitant reversibility of thrombocytopenia and of clinical GvHD signs under immunosuppressive therapy . Furthermore, a low platelet count was proposed as an indicator of GvHD severity, and persistent thrombocytopenia has been described as an independent predictor of worse outcomes in patients with chronic and acute GvHD . Remarkably, patients with persistent thrombocytopenia do not die of hemorrhagic events, but rather other GvHD‐associated complications, particularly infections.…”

“…Nevertheless, one‐third of these patients will exhibit an increase in megakaryocytopoiesis consistent with peripheral platelet destruction and recently, thrombopoiesis, as determined by the peripheral blood absolute immature platelet number, was reported to be markedly elevated in thrombopenic patients with chronic GvHD, thus providing evidence against myelosuppression . In contrast to thrombopoiesis, myelopoiesis and erythropoiesis have not regularly been described as affected during GvHD . However, the number of cell lineages affected by cytopenia has been associated with an inferior outcome .…”