Abstract
Ten patients experiencing primary graft failure after allogeneic bone marrow transplantation received autologous marrow or blood cells as hematopoietic rescue 21-40 (median 22.5) days after the original transplant after which immunosuppression with cyclosporine was tapered off rapidly. The leukocyte count at the time of rescue was 0.1-0.3 x 109/l with <0.1 x 109/l neutrophils. The clinical course was uneventful after rescue with hematologic recovery to 0.5 x 109/l neutrophils occurring 9-61 days (median 20) later in nine patients, and to 50 x 109/l platelets 17-595 days (median 40) later in eight patients. No patient had a life-threatening infection at the time of or after rescue. No patient experienced acute graft-versus-host disease. Four patients with acute leukemia had recurrent disease 46-117 days after autologous rescue, and died of relapse. Five patients with acute leukemia are alive in continuous remission at 270-3382 days, and one patient with chronic myeloid leukemia is alive in hematologic remission at 228 days. We conclude that infusion of back-up autologous cells can prevent the immediate infectious consequences of primary allogeneic graft failure through consistent myeloid recovery, and may result in long-term survival of patients with good-risk disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 213-217 |
| Number of pages | 5 |
| Journal | Bone Marrow Transplantation |
| Volume | 17 |
| Issue number | 2 |
| State | Published - Feb 1996 |
Funding
This work was supported by The Francis Crick Institute, which receives its core funding from Cancer Research UK (FC001202), the UK Medical Research Council (FC001202) and the Wellcome Trust (FC001202) (M.T. and P.V.L.). M.T. is supported as a postdoctoral fellow by the European Union’s Horizon 2020 research and innovation program (Marie Skłodowska-Curie Grant agreement no. 747852-SIOMICS). P.V.L. is a Winton Group Leader in recognition of the Winton Charitable Foundation’s support toward the establishment of The Francis Crick Institute. I.M. is funded by a Cancer Research UK Career Development Fellowship (C57387/A21777). D.C.W. is funded by the Li Ka Shing Foundation. This work was supported by grant 1U24CA210957 to P.T.S.. F.M. acknowledges support from the University of Cambridge, Cancer Research UK and Hutchison Whampoa Limited. Parts of this work were funded by Cancer Research UK core grant C14303/A17197 (F.M.). This project was enabled through access to the MRC eMedLab Medical Bioinformatics infrastructure, supported by the UK Medical Research Council (grant no. MR/ L016311/1) (M.T. and P.V.L.). Parts of the results published here are based on data generated by the TCGA Research Network (http://cancergenome.nih.gov/). A.S. is supported by the Chris Rokos Fellowship in Evolution and Cancer and by Cancer Research UK (A22909). T.A.G. is supported by Cancer Research UK (A19771). C.P.B. is supported by the Wellcome Trust (097319/Z/11/Z). B.W. is supported by a Geoffrey W. Lewis Post-Doctoral Training fellowship. A.S. and T.A.G. are jointly supported by the Wellcome Trust (202778/B/16/Z and 202778/Z/16/Z, respectively). This work was also supported by Wellcome Trust funding to the Centre for Evolution and Cancer (105104/Z/14/Z).
Keywords
- Allogeneic bone marrow transplantation
- Autologous bone marrow transplantation
- Graft failure
- Graft rejection
- Graft-versus-leukemia
ASJC Scopus subject areas
- Hematology
- Transplantation