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Salvage with a mini-allograft after primary engraftment failure following autologous transplant for multiple myeloma

Bone Marrow Transplantation volume 39, pages 239–240 (2007)Cite this article

A 45-year-old patient with IgG myeloma was found to be refractory to five cycles of continuous infusion cyclophosphamide, vincristine, doxorubicin and dexamethasone. Approximately 50% reduction in paraprotein was achieved with 6 months of thalidomide and dexamethasone. An autograft was planned, but in view of the young age and poor response to initial chemotherapy, human leukocyte antigen (HLA) typing was performed for a possible mini-allograft in the event of a poor response to the autograft. A brother was found to be HLA-identical. Autologous stem cells were mobilized with 5 days of granulocyte-colony stimulating factor (G-CSF) (10 μg/kg in two divided doses per day). The total number of cells collected over 2 days of apheresis was 2.56 × 108 mononuclear cells/kg with a CD34+ cell dose of 5 × 106/kg.

Melphalan was administered at the dose of 200 mg/m2 and unmanipulated stem cells were infused the next day. G-CSF was started on day +7. Neutropenic fever was treated with meropenem, teicoplanin and amphotericin B. He continued to remain pancytopenic on day +18. Bone marrow on day +19 revealed marked hypocellularity with no evidence of myeloma. New parenchymal lung infiltrates developed consistent with a breakthrough fungal infection on a chest computerized tomography scan. As there was no evidence of engraftment by day +21, it was decided to proceed with a mini-allograft from the HLA-identical sibling.

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Authors and Affiliations

  1. Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India

    K Subramaniam, B George, V Mathews, A Viswabandya, A Srivastava & M Chandy

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  1. K Subramaniam
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  2. B George
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  3. V Mathews
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  4. A Viswabandya
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  6. M Chandy
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Correspondence to B George.

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Subramaniam, K., George, B., Mathews, V. et al. Salvage with a mini-allograft after primary engraftment failure following autologous transplant for multiple myeloma. Bone Marrow Transplant 39, 239–240 (2007). https://doi.org/10.1038/sj.bmt.1705567

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