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Background
Autologous stem cell transplant (ASCT) is commonly performed to consolidate treatment response in selected hematology malignancy. Poor graft function (PGF) is a not an uncommon complication post ASCT, but with limited data in our cohort.
Method
Among the 140 ASCT performed from January 2023 until March 2024, 11 patients with PGF post ASCT were retrospectively identified and analyzed. PGF is defined as platelet counts <50,000/uL, ANC <1000/mm3, hemoglobin <8g/dl, or requirement of transfusions of blood products starting at +30 days post ASCT.
Result
The prevalence of PGF in our cohort was 7.8%. Among the patients with PGF, 4 have plasma cell neoplasm, 3 primary CNS lymphoma, 3 acute promyelocytic leukemia and 1 diffuse large B cell lymphoma, with median age of 48-year-old (16รข??66-year-old). The median follow up time was 6.5 months (2 -13 months). 7 patients collected at first attempt with G-CSF mobilization. 4 patients failed G-CSF mobilization, they were then remobilized with chemotherapy and collected. The median CD34 cell collected and infused was 3.04x106/kg (2.06 -6.68 x106/kg), with viability of 98% before infusion. All patient received full myeloablative conditioning. Median duration for G-CSF administration post infusion, was 10 days (7-17 days). Median neutrophil engraftment is 11 days (10-17 days), while platelet engraftment is 13 days (10-27days). Among the patients with PGF, the median time for full hematopoietic recovery is 3.5 months and each patient require an average of 4-unit pack cells and 5-unit apheresis platelets, during the follow up period. 3 patients were still having PGF after 6 months ASCT. 2 deaths were reported, due to severe pneumonia and disease relapse respectively. Our cohort is too small to draw any statistically significant correlation.
Conclusion
PGF remains a common complication after ASCT. Its occurrence incurs higher health care cost and adversely affects patient overall survival. Malignant bone marrow diseases, difficult stem cell mobilization and a low infused CD34 cell dose were risk factors for PGF. |
