Clinical predictors of delayed engraftment in autologous hematopoietic cell transplant recipients

Abstract

Objective/background: Clinical predictors of delayed engraftment following autologous hematopoietic cell transplantation (AHCT) are poorly described in the literature. The purpose of this study was to identify pretransplant characteristics contributing to delayed engraftment (DE) following AHCT.

Methods: A retrospective, single institution study of 1162 consecutive patients undergoing AHCT from January 1996 to August 2016 was studied for DE. DE was defined as platelet count ≤ 50,000/µl, hemoglobin ≤ 8 g/dL, or absolute neutrophil count ≤ 1000/mm³.

Results: Of the 1162 AHCT recipients, 263 (22.6%) were identified as having DE at 30-days post-AHCT with 80.0% being solely due to delayed platelet engraftment. Patients with Non-Hodgkin lymphoma (NHL) represented 18% of the original cohort, but accounted for 45% of those with DE, whereas multiple myeloma patients represented 59% of the initial cohort, but only 29% of those that had DE. At 3 months post-AHCT, transfusion dependence (p = .0083) prior to AHCT, low-infused CD34⁺ cell dose < 3 × 10⁶/kg (p = .0012), and low preAHCT platelet count < 150 × 10³/µL (p = .0027) were significantly associated with delayed engraftment.

Conclusion: Transfusion dependence prior to AHCT, pre-AHCT platelet count, and CD34⁺ cell dose were the strongest predictors of delayed engraftment in patients undergoing AHCT.

Keywords: Autologous transplant; Delayed engraftment; Graft function; Hematopoietic cell transplant; Lymphoma; Myeloma.