¹Sections of Hematology and Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Correspondence: Dr K-H Lee, Department of Internal Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea. E-mail: khlee2@amc.seoul.kr

Received 5 June 2003; Accepted 23 October 2003; Published online 2 February 2004.

Abstract

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=22; failure of platelet >20 000/l or red blood cell transfusion independence/reticulocyte count 1.0% by day 60) or subsequent (n=21, ANC <500/l for 3 days, platelet <20 000/l for 7 days, or red blood cells transfusion/reticulocyte <1.0% after initial trilineage reconstitution) failure. GVHD was the most common clinical condition associated with cytopenia (n=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=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.