Autologous peripheral blood stem cell transplantation among lymphoproliferative disease patients: factors influencing engraftment

Objectives: Autologous peripheral blood stem cells transplantation [APBSCT] is a therapeutic option which can be used in various hematological, neoplastic disorders including lymphoproliferative disease [LPD]. Differences in patient populations and treatment modalities in different transplant centers mean it is important to improve the knowledge of the different factors affecting engraftment after APBSCT for the success of this procedure. We sought to determine the factors influencing neutrophil and platelet engraftment after APBSCT in patients with LPD

Methods: We conducted a retrospective review of 70 patients with LPD [35 with lymphoma and 35 with multiple myeloma] who had undergone APBSCT between January 2008 and December 2016. Data obtained included disease type, treatment, and stem cell characteristics. Kaplan-Meier analysis was performed for probabilities of neutrophil and platelet engraftment occurred and was compared by the log-rank test. The multivariate Cox proportional hazards regression model was used for the analysis of potential independent factors influencing engraftment. A p-value < 0.050 was considered statistically significant

Results: Most patients were ethnic Malay, the median age at transplantation was 49.5 years. Neutrophil and platelet engraftment occurred in a median time of 18 [range 4–65] and 17 [range 6–66] days, respectively. The majority of patients showed engraftment with 65 [92.9%] and 63 [90.0%] showing neutrophil and platelet engraftment, respectively. We observed significant differences between neutrophil engraftment and patient's weight [< 60/>/= 60 kg], stage of disease at diagnosis, number of previous chemotherapy cycles [< 8/>/= 8], and pre-transplant radiotherapy. While for platelet engraftment, we found significant differences with gender, patient's weight [< 60/>/= 60 kg], pre-transplant radiotherapy, and CD34+ dosage [< 5.0/>/= 5.0 × 106/kg and < 7.0/>/= 7.0 × 106/kg]. The stage of disease at diagnosis [p = 0.012] and pre-transplant radiotherapy [p = 0.025] were found to be independent factors for neutrophil engraftment whereas patient's weight [< 60/>/= 60 kg, p = 0.017], age at transplantation [< 50/>/= 50 years, p = 0.038], and CD34+ dosage [< 7.0/>/= 7.0 × 106/kg, p = 0.002] were found to be independent factors for platelet engraftment

Conclusions: Patients with LPD who presented at an early stage and with no history of radiotherapy had faster neutrophil engraftment after APBSCT, while a younger age at transplantation with a higher dose of CD34+ cells may predict faster platelet engraftment. However, additional studies are necessary for better understanding of engraftment kinetics to improve the success of APBSCT

Anti-M induced severe haemolytic disease of foetus and newborn in a Malay woman with recurrent pregnancy loss

Haemolytic disease of the foetus and newborn (HDFN) is caused by maternal red blood cells (RBC) alloimmunisation resulted from incompatibility of maternal and foetal RBCs. However, only a few HDFN attributed to anti-M were reported, varying from asymptomatic to severe anaemia with hydrops foetalis and even intrauterine death. A case of severe HDFN due to anti-M alloantibody from an alloimmunized grandmultiparous Malay woman with recurrent pregnancy loss is reported here. The newborn was delivered with severe and prolonged anaemia which required frequent RBC transfusions, intensive phototherapy and intravenous immunoglobulin administration. Although anti-M is rarely known to cause severe HDFN, a careful serological work-up and close assessment of foetal well-being is important, similar to the management of RhD HDFN. Alloimmunisation with anti-M type can lead to severe HDFN and even foetal loss.