Outcomes of spinal fusion following autologous stem cell transplantation

Patients who have undergone myeloablative chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) for conditions such as multiple myeloma, Hodgkin's disease, and primary amyloidosis may be at higher risk for failure of spinal fusion. As HSCT care and outcomes continue to improve, it is increasingly likely that neurosurgeons will encounter patients post-HSCT who require spinal procedures. To our knowledge there are no published data on fusion outcomes in this unique patient population. We report three patients who underwent spinal fusion following an autologous HSCT. Spinal surgery was performed, on average, 4.5 years after autologous HSCT. No patients were on immunosuppressant chemotherapy at the time of the procedure, although one patient was being treated with rituximab for disease progression peri-operatively. Average radiographic confirmation of fusion was 37 months and all patients ultimately demonstrated fusion, although not without incident. Our results suggest that spinal fusion can occur in patients who have previously undergone myeloablative chemotherapy followed by autologous HSCT.