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Second marrow infusion for poor graft function after allogeneic marrow transplantation
G B Bolger1, K M Sullivan, R Storb
1Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Bone Marrow Transplantation
|May 1, 1986
Summary
Second marrow infusions improved hematopoietic recovery in patients with poor graft function post-transplant. However, this approach was associated with increased graft-versus-host disease (GVHD) and its long-term impact remains unclear.
Area of Science:
- Hematology
- Immunology
- Transplantation
Background:
- Persistent poor graft function after allogeneic marrow transplantation poses a significant clinical challenge.
- Graft failure can occur without evident rejection or residual malignancy, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of a second marrow infusion in patients experiencing poor graft function post-allogeneic marrow transplantation.
- To assess hematopoietic recovery and the incidence of graft-versus-host disease (GVHD) following a booster marrow infusion.
Main Methods:
- A cohort of 57 patients with poor graft function received a second marrow infusion from their original donor.
- No preparative reconditioning was administered before the second infusion.
- Patients were monitored for hematopoietic recovery (neutrophil count, platelet independence) and GVHD.
Main Results:
- Of 34 evaluable patients, all achieved adequate neutrophil counts, and 20 became platelet transfusion-independent.
- Acute graft-versus-host disease (GVHD) was observed in 86% of patients, with increased severity or new onset in 24 patients post-boost.
- Chronic GVHD developed in all patients surviving over 150 days; 10 patients survive long-term with normal hematologic function.
Conclusions:
- Second marrow infusions can lead to hematopoietic reconstitution in patients with poor graft function.
- The procedure is associated with a high incidence of acute and chronic GVHD, and the precise benefit of the boost requires further investigation due to the lack of a control group.