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Success of the autologous stem cell boost after autologous graft failure in multiple myeloma and AL amyloidosis

Bone Marrow Transplantation volume 57, pages 1007–1009 (2022)Cite this article

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Autologous stem cell transplantation (ASCT) involves the administration of high dose conditioning chemotherapy followed by autologous stem cell rescue to ameliorate the resultant myelosuppression and remains a critical component of therapy in Multiple Myeloma (MM) and light chain amyloidosis (AL) [1]. While the introduction of anti-CD38 therapies have invigorated the treatment paradigm for AL, ASCT remains an important treatment option [2, 3]. Primary or secondary graft failure are rare but serious complications of ASCT. Protracted cytopenias lead to multiple transfusions, infections, prolonged hospitalizations, increased financial burden, and higher mortality [4]. The infusion of an unmanipulated fraction of the original cells collected for transplantation without the administration of conditioning chemotherapy, which we have termed “autologous stem cell boost” (ASCB), is utilized to manage autologous primary and secondary graft failures. The effectiveness of this procedure has been anecdotal given the infrequent occurrence of autologous graft failure. In this descriptive study, we investigated effectiveness of the ASCB in patients with either MM or AL who experienced either primary or secondary graft failure after ASCT.

We retrospectively reviewed records from 2002 to 2020 for adult patients with MM or AL who underwent ASCT then received ASCB without utilizing conditioning chemotherapy. Primary graft failure (PGF) was defined as the absence of initial hematopoietic cell engraftment defined by peripheral blood absolute neutrophil count (ANC) < 0.5 × 109/L and platelets <20 × 109/L by day + 21 post ASCT. Secondary graft failure (SGF) was defined as initial engraftment and subsequent loss of graft with decrease in ANC to <0.5 × 109/L and platelets <20 × 109/L. Subsequent engraftment of the stem cell boost was defined as ANC > 0.5 × 109 for 2 consecutive days, and platelets >20 for 2 consecutive days, without the need for platelet transfusion for 7 consecutive days.

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Data availability

The data that support the findings of this study are available from the corresponding author [JC] upon reasonable request.

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Author notes

  1. These authors contributed equally: Joselle Cook, Wilson I. Gonsalves.

Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Joselle Cook, Wilson I. Gonsalves, Morie A. Gertz, Alissa Visram, Rahma Warsame, Martha Q. Lacy, Angela Dispenzieri, David Dingli, Prashant Kapoor, Taxiarchis V. Kourelis, Suzanne R. Hayman, Robert A. Kyle, Eli Muchtar, Shaji K. Kumar, William J. Hogan & Francis K. Buadi

  2. University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Alissa Visram

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Eapen K. Jacob

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  1. Joselle Cook
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Contributions

JC, WG and FB conceived and designed the study. JC, WG and MG collected and retrieved the data. JC, WG, and FB analyzed and interpreted the results. JC, WG, EJ and FB drafted the. MG, AV, RW, MQL, AD, DD, PK, TK, SH, RK, EM, SK, WH, EJ critically reviewed and edited the paper and approved of the manuscript.

Corresponding author

Correspondence to Joselle Cook.

Ethics declarations

Competing interests

AD: Alnylam: Research Funding; Celgene: Research Funding; Janssen: Research Funding; Takeda: Research Funding; Intellia: Research Funding; Pfizer: Research Funding. DD: Grant/Research funding from Juno, Celgene. MG: personal fees from Ionis/Akcea, personal fees from Alnylam, personal fees from Prothena, personal fees from Sanofi, personal fees from Janssen, grants and personal fees from Spectrum, personal fees from Annexon, personal fees from Appellis, personal fees from Amgen, personal fees from Medscape, personal fees from Physicians Education Resource, personal fees for Data Safety Monitoring board from Abbvie, and Celgene personal fees from Research to Practice, Speaker fees from Johnson and Johnson; Speaker fees from Medscape, Speaker fees DAVA oncology; Advisory Board for Pharmacyclics Advisory Board for Proclara outside the submitted work; Development of educational materials for i3Health. Educational Program development i3Health. Royalties from Springer Publishing. Grant Funding Amyloidosis Foundation; International Waldenstrom Foundation. NCI SPORE MM SPORE 5P50 CA186781-04 PK: Research funding (Takeda, Celgene, and Amgen). SK: Consulting or advisory Role with Takeda, Janssen Oncology, Amgen, AbbVie, Merck, Celgene, Genentech/Roche, Oncopeptides, Kite, a Gilead company, Genecentrix, Molecular Partners, Bluebird Bio, Cellectar and research Funding: Celgene, Takeda, AbbVie, Novartis, Sanofi, Janssen Oncology, Merck, Kite, a Gilead company, MedImmune, Roche/Genentech, TeneoBio, CARsgen Therapeutics. MQL: Research funding (Celgene)

Ethics

The study was conducted in accordance with the Declaration of Helsinki.

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Cook, J., Gonsalves, W.I., Gertz, M.A. et al. Success of the autologous stem cell boost after autologous graft failure in multiple myeloma and AL amyloidosis. Bone Marrow Transplant 57, 1007–1009 (2022). https://doi.org/10.1038/s41409-022-01659-w

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