Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in Acute Nonlymphocytic Leukemia 63
RESULTS
Posttransplantation Clinical Course
Most patients receiving busulfan and cyclophosphamide had moderate
oral mucositis, which responded to good oral hygiene but which on occasion
required the topical application of agents such as lidocaine and diphenhydramine.
Mucositis generally resolved within 2 weeks after transplantation.
No episodes of severe life-threatening hemorrhage were observed. All patients
had fever during aplasia. Six patients died of overwhelming sepsis during
aplasia, 8-24 days after marrow rescue: two with Pseudomonas aeruginosa,
one with Streptococcus viridans, two with Candida tropicalis, and one with
aspergillus. One patient died with multiple organ system failure and presumptive
sepsis 34 days after transplantation, though no specific organism was
identified in blood cultures. One patient, who had nonfatal sepsis with
Klebsiella pneumoniae at the time of marrow infusion, had persistent marrow
hypoplasia and died with gram-negative sepsis 155 days after BMT. One patient
died with interstitial pneumonitis owed to cytomegalovirus while in third
remission 95 days after BMT, and another patient in second remission died with
idiopathic interstitial pneumonitis 249 days after BMT. One patient developed
nonfatal pneumonitis attributable to Pneumocystis carinii 130 days after
transplantation. Two patients, both in third remission, died with hepatic venoocclusive
disease, one 35 and the other 47 days after infusion of 4-HC-treated
autologous marrow.
Hematologic Reconstitution
Marrow samples from most patients had no detectable CFGs-GM after
incubation with 4-HC. Ameanof0.59 + 0.20(range,0-5.1)x 10 3 CFUs-GM/kg
was infused. Thirty-three patients were évaluable for engraftment (the seven
patients who died with sepsis during aplasia were excluded from analysis). One
patient with leukemia in second remission had Klebsiella pneumoniae sepsis,
acute renal failure, and hemodynamic instability at the time of autologous
marrow infusion. Although she recovered from that episode of sepsis, she had
persistently low levels of leukocytes, neutrophils, and platelets after transplantation
(total leukocytes < 0.4
x
10 9 /l, neutrophils < 0.1 x 10 9 /1, and platelets
< 20 x 10 9 /l). The patient had no reserve marrow available for infusion after
failure to engraft with the 4-HC-treated fraction and died with gram-negative
bacterial sepsis 155 days after autologous marrow infusion. Hematologic
reconstitution occurred in the other 32 patients, and none required infusion of
reserve marrow. In these patients, the median time required to attain a
neutrophil count greater than 0.5 x 10 9 /l was 29 days (range, 14-63 days) after
BMT. Six patients had recovery of neutrophils but were thrombocytopenic
(platelets, 10-35 x 10 9 /1) at the time of leukemic relapses, 73-176 days after
autologous marrow rescue. One patient remains in second remission with