Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Autografting

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

Abstract

We performed a single center retrospective analysis of 84 autologous hemopoietic stem cell transplants done for AML to characterize the pattern of hemopoietic engraftment, post-transplant cytopenia and their impact on survival outcome. Following autologous transplant and engraftment, 30 patients (35.7%) had a transient secondary decline in their plt counts, which was not associated with graft rejection, relapse or infection. The median time to onset of thrombocytopenia was 59 days post transplant, with spontaneous recovery after a median period of 41 days. A secondary decline in ANC also occurred in eight patients. Patients with secondary plt decline had a significantly earlier primary plt engraftment (median 15 days) and a trend towards earlier neutrophil engraftment compared with patients who maintained steady plt counts (median 21 days). There was a trend towards a lower incidence of secondary plt decline in patients who received BM stem cells compared with those who received PBSC. No cause was evident for the occurrence of a secondary cytopenia, and it did not adversely affect survival. We conclude that secondary cytopenia is a common and harmless occurrence after autologous transplant especially from PBSC graft.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Kolitz JE . Current therapeutic strategies for acute myeloid leukaemia. Br J Haematol 2006; 134: 555–572.

    Article  CAS  PubMed  Google Scholar 

  2. Leopold LH, Willemze R . The treatment of acute myeloid leukemia in first relapse: a comprehensive review of the literature. Leuk Lymphoma 2002; 43: 715–727.

    Article  Google Scholar 

  3. Collisson EA, Lashkari A, Malone R, Paquette R, Emmanouilides C, Territo MC et al. Long-term outcome of autologous transplantation of peripheral blood progenitor cells as postremission management of adult acute myelogenous leukemia in first complete remission. Leukemia 2003; 17: 2183–2188.

    Article  CAS  PubMed  Google Scholar 

  4. Mehta J, Powles R, Singhal S, Horton C, Tait D, Milan S et al. Autologous bone marrow transplantation for acute myeloid leukemia in first remission: identification of modifiable prognostic factors. Bone Marrow Transplant 1995; 16: 499–506.

    CAS  PubMed  Google Scholar 

  5. Gondo H, Harada M, Miyamoto T, Takenaka K, Tanimoto K, Mizuno S et al. Autologous peripheral blood stem cell transplantation for acute myelogenous leukemia. Bone Marrow Transplant 1997; 20: 821–826.

    Article  CAS  PubMed  Google Scholar 

  6. Linker CA, Damon LE, Ries CA, Navarro WA, Case D, Wolf JL . Autologous stem cell transplantation for advanced acute myeloid leukaemia. Bone Marrow Transplant 2002; 29: 297–301.

    Article  CAS  PubMed  Google Scholar 

  7. Linker CA, Ries CA, Damon LE, Sayre P, Navarro W, Rugo HS et al. Autologous stem cell transplantation for acute myeloid leukaemia in first remission. Biol Blood Marrow Transplant 2000; 6: 50–57.

    Article  CAS  PubMed  Google Scholar 

  8. Reiffers J, Lapin M, Sanz M, Korbling M, Blaise D, De La Rubia J et al. Autologous versus marrow transplantation for acute myeloid leukaemia in complete remission: an EBMT retrospective analysis. Bone Marrow Transplant 2000; 25: 1115–1119.

    Article  CAS  PubMed  Google Scholar 

  9. Cassileth PA, Harrington DP, Appelbaum FR, Lazarus HM, Rowe JM, Paietta E et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukaemia. New Eng J Med 1998; 339: 1649–1656.

    Article  CAS  PubMed  Google Scholar 

  10. Michallet AS, Chelghoum Y, Thiebaut A, Le QH, Prebet T, Tavernier E et al. Autologous haemopoietic stem cell transplantation for adults with acute myeloid leukaemia in complete remission: The Edouard Herriot hospital experience. Hematology 2006; 11: 157–164.

    Article  PubMed  Google Scholar 

  11. Specchia G, Pastore D, Mestice A, Liso A, Carluccio P, Leo M et al. Early and long-term engraftment after autologous peripheral stem cell transplantation in acute myeloid leukemia patients. Acta Haematol 2006; 116: 229–237.

    Article  PubMed  Google Scholar 

  12. Pendry K, Alcorn MJ, Burnett AK . Factors influencing haematological recovery in 53 patients with acute myeloid leukaemia in first remission after autologous bone marrow transplantation. Br J Haematol 1993; 83: 45–52.

    Article  CAS  PubMed  Google Scholar 

  13. Weaver CH, Hazelton B, Birch R, Palmer P, Allen C, Schwartzberg L et al. An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collection in 692 patients after the administration of myeloablative chemotherapy. Blood 1995; 86: 3961–3969.

    CAS  PubMed  Google Scholar 

  14. Bernstein SH, Nademanee AP, Vose JM, Tricot G, Fay JW, Negrin RS et al. A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation. Blood 1998; 91: 3509–3517.

    CAS  PubMed  Google Scholar 

  15. Nash RA, Gooley T, Davis C, Appelbaum FR . The problem of thrombocytopenia after hematopoietic stem cell transplantation. Stem Cells 1996; 14: 261–273.

    Article  PubMed  Google Scholar 

  16. Verdonck LF, de Gast GC, van Heugten HG, Nieuwenhuis HK, Dekker AW . Cytomegalovirus infection causes delayed platelet recovery after bone marrow transplantation. Blood 1991; 78: 844–848.

    CAS  PubMed  Google Scholar 

  17. Reddy RL . Mobilization and collection of peripheral blood progenitor cells for transplantation. Transfus Apher Sci 2005; 32: 63–72.

    Article  PubMed  Google Scholar 

  18. Shpall EJ, Champlin R, Glaspy JA . Effect of CD34+ peripheral blood progenitor cell dose on hematopoietic recovery. Biol Blood Marrow Transplant 1998; 4: 84–92.

    Article  CAS  PubMed  Google Scholar 

  19. Weaver CH, Potz J, Redmond J, Tauer K, Schwartzberg LS, Kaywin P et al. Engraftment and outcomes of patients receiving myeloablative therapy followed by autologous peripheral blood stem cells with a low CD34+ cell content. Bone Marrow Transplant 1997; 19: 1103–1110.

    Article  CAS  PubMed  Google Scholar 

  20. Yoong Y, Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Litzow MR et al. The effect of absolute lymphocyte count recovery kinetics on survival after autologous stem cell transplantation for non-Hodgkin's lymphoma. Leuk Lymphoma 2005; 46: 1287–1294.

    Article  PubMed  Google Scholar 

  21. Porrata LF, Gertz MA, Geyer SM, Litzow MR, Gastineau DA, Moore SB et al. The dose of infused lymphocytes in the graft directly correlates with clinical outcome after autologous peripheral blood hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2004; 18: 1085–1092.

    Article  CAS  PubMed  Google Scholar 

  22. Kim H, Sohn HJ, Kim SE, Kang HJ, Park S, Kim S et al. Lymphocyte recovery as a positive predictor of prolonged survival after autologous peripheral blood stem cell transplantation in T-cell non-Hodgkin's lymphoma. Bone Marrow Transplant 2004; 34: 43–49.

    Article  CAS  PubMed  Google Scholar 

  23. Porrata LF, Gertz MA, Litzow MR, Lacy MQ, Dispenzieri A, Inwards DJ et al. Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation for patients with primary systemic amyloidosis. Clin Cancer Res 2005; 11: 1210–1218.

    CAS  PubMed  Google Scholar 

  24. Joao C, Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB et al. Early lymphocyte recovery after autologous stem cell transplantation predicts superior survival in mantle-cell lymphoma. Bone Marrow Transplant 2006; 37: 865–871.

    Article  CAS  PubMed  Google Scholar 

  25. Porrata LF, Litzow MR, Tefferi A, Letendre L, Kumar S, Geyer SM et al. Early lymphocyte recovery is a predictive factor for prolonged survival after autologous hematopoietic stem cell transplantation for acute myelogenous leukemia. Leukemia 2002; 16: 1311–1318.

    Article  CAS  PubMed  Google Scholar 

  26. Ninan MJ, Flowers CR, Roback JD, Arellano ML, Waller EK . Post transplant thrombopoiesis predicts survival in patients undergoing autologous haemopoietic progenitor cell transplantation. Biol Blood Marrow Transplant 2007; 13: 895–904.

    Article  PubMed  Google Scholar 

  27. Bruno B, Gooley T, Sullivan KM, Davis C, Bensinger WI, Storb R et al. Secondary failure of platelet recovery after haemopoietic stem cell transplantation. Biol Blood Marrow Transplant 2001; 7: 154–162.

    Article  CAS  PubMed  Google Scholar 

  28. Narimatsu H, Emi N, Kohno A, Iwai M, Yanada M, Yokozawa T et al. High incidence of secondary failure of platelet recovery after autologous and syngeneic peripheral blood stem cell transplantation in acute promyelocytic leukaemia. Bone Marrow Transplant 2007; 40: 773–778.

    Article  CAS  PubMed  Google Scholar 

  29. Kaplan E, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  30. Kwong YL, Millar JL, Powles RL . Recovery of circulating haemopoietic progenitor cells in the early phase of haemopoietic reconstitution after autologous and allogeneic bone marrow transplantation. Bone Marrow Transplant 1989; 4: 575–581.

    CAS  PubMed  Google Scholar 

  31. Gunn N, Damon L, Varosy P, Navarro W, Martin T, Ries C et al. High CD34+ cell dose promotes faster platelet recovery after autologous stem cell transplantation for acute myeloid leukemia. Biol Blood Marrow Transplant 2003; 9: 643–648.

    Article  PubMed  Google Scholar 

  32. de la Rubia J, Sanz GF . Autologous peripheral blood stem cell transplantation for acute leukaemias. Bailliereres Clin Haematol 1999; 12: 139–150.

    Article  CAS  Google Scholar 

  33. Pérez-Simón JA, Martín A, Caballero D, Corral M, Nieto MJ, Gonzalez M et al. Clinical significance of CD34+ cell dose in long-term engraftment following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 24: 1279–1283.

    Article  PubMed  Google Scholar 

  34. Porrata LF, Markovic SN . Timely reconstitution of immune competence affects clinical outcome following autologous stem cell transplantation. Clin Exp Med 2004; 4: 78–85.

    Article  CAS  PubMed  Google Scholar 

  35. Guillaume T, Rubinstein DB, Symann M . Immune reconstitution and immunotherapy after autologous hematopoietic stem cell transplantation. Blood 1998; 92: 1471–1490.

    CAS  PubMed  Google Scholar 

  36. Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Gastineau DA et al. Early lymphocyte recovery predicts superior survival after autologous stem cell transplantation in non-Hodgkin lymphoma: a prospective study. Biol Bone Marrow Transplant 2008; 14: 807–816.

    Article  Google Scholar 

  37. Kamel AM, El-Sharkawy N, Mahmoud K, Khalaf MR, El Haddad A, Fahmy O et al. Impact of CD34 subsets on engraftment kinetics in allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 2005; 35: 129–136.

    Article  CAS  PubMed  Google Scholar 

  38. Ma DDF, Varga DE, Biggs JC . Haemopoietic reconstitution after allogeneic bone marrow transplantation in man: recovery of haemopoietic progenitors (CFU-Mix, BFU-E and CFU-GM). Br J Haematol 1987; 65: 5–12.

    Article  CAS  PubMed  Google Scholar 

  39. Hassan HT, Zander AR . Thrombocytopaenia after high-dose chemotherapy and autologous stem cell transplantation: an unresolved problem and possible approaches to resolve it. J Haematother 1996; 5: 407–414.

    Article  CAS  Google Scholar 

  40. Hequet O, Salles G, Ketterer N, Espinouse D, Dumontet C, Thieblemont C et al. Autoimmune thrombocytopaenic purpura after autologous stem cell transplantation. Bone Marrow Transplant 2003; 32: 89–95.

    Article  CAS  PubMed  Google Scholar 

  41. Jillella AP, Kallab AM, Kutlar A . Autoimmune thrombocytopaenia following autologous haemopoietic stem cell transplantation: review of literatures and treatment options. Bone Marrow Transplant 2000; 26: 925–927.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Dr Babatunde acknowledges the support provided by the University of Ilorin Teaching Hospital, Ilorin, Nigeria and the Postgraduate Medical Institute (PGMI), Singapore General Hospital, for the Clinical Fellowship in Bone Marrow Transplantation at the Department of Haematology, Singapore General Hospital. We would like to thank the research coordinators Ms Valerie Wee and Ms Perumal Premalatha for their assistance in providing the data, and the nursing and paramedical staff in the Department of Haematology for their excellent work in patient care. This study is supported by the Singapore Cancer Syndicate Grant for Bone Marrow Transplant Consortium Registry.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Y C Linn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Babatunde, A., Tan, D., Heng, K. et al. Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome. Bone Marrow Transplant 44, 175–183 (2009). https://doi.org/10.1038/bmt.2009.1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.1

Keywords

Search

Quick links