Failure of trilineage blood cell reconstitution after initial neutrophil engraftment in patients undergoing allogeneic hematopoietic cell transplantation - frequency and outcomes

The outcomes of patients who experience the failure to reconstitute a trilineage of blood cells after initial neutrophil engraftment were evaluated in 178 patients with hematologic disorders, who underwent allogeneic HCT. Of 165 qualified patients (five with primary engraftment failure; eight deaths before day 60 of HCT), 43 ( 26%) satisfied the criteria for the initial ( n = 22; failure of platelet > 20 000/mul or red blood cell transfusion independence/reticulocyte count greater than or equal to 1.0% by day 60) or subsequent ( n = 21, ANC < 500/μl for ≥ 3 days, platelet < 20 000/mul for greater than or equal to 7 days, or red blood cells transfusion/ reticulocyte < 1.0% after initial trilineage reconstitution) failure. GVHD was the most common clinical condition associated with cytopenia ( n = 24). In all, 20 patients ( 47%) recovered at least partially with a median of 52 days ( range 8 - 323) later, with 12 of those 20 patients recovering completely. The eventual reconstitution failure rate was 14% ( 23/ 163 patients). The number of cell lineages involved in the cytopenia was the only independent variable that predicted partial recovery ( 1 lineage vs 2 - 3 lineages with odds ratio of 8.69 ( 95% CI 1.96 - 38.60), P = 0.004). Five/ 20 patients with vs 20/ 23 patients without partial recovery died. Trilineage reconstitution failures after allogeneic HCT need systematic analysis in the future studies.