Factors affecting engraftment and hematopoietic recovery after unpurged autografting in acute leukemia

Factors affecting hematologic recovery to 0.5 x 10⁹/l neutrophils and 50 x 10⁹/I platelets after unpurged autografting (210 marrow, 30 blood) were analyzed in 240 patients with acute myeloid (AML, n = 128) or lymphoblastic (ALL, n = 112) leukemia. Cytokines were not administered routinely after transplant. Age, sex and cryopreservation did not influence hematologic recovery in multivariate analysis. Blood cell grafts (P < 0.0001), ALL (P = 0.003), and a nucleated cell dose of ≤ 2 x 10⁸/kg (P = 0.035) were associated with faster neutrophil recovery. First remission (P = 0.001), a higher cell dose (P = 0.011), ALL (P = 0.023), and a short remission-transplant interval (P = 0.023) were associated with faster platelet recovery. There was a strong correlation between blood cell grafts and higher cell doses, and marrow and lower cell doses. Amongst marrow recipients, neutrophil recovery was faster in ALL (P = 0.001) and with higher cell doses (P = 0.032). Platelet recovery was faster in first remission patients (P = 0.005) and ALL (P = 0.043), and with higher cell doses (P = 0.031). We conclude that hematologic recovery after autografting is faster in ALL and first remission patients, probably due to the nature and the amount of prior chemotherapy. Using blood stem cells hastens engraftment, but even if marrow is used due to concern over relapse with blood, higher cell doses are associated with faster recovery.