Transplantation without Growth Factor. Engraftment Kinetics Following Stem Cell Transplantation for Primary Systemic Amyloidosis.

Gertz, Morie Abraham; Lacy, Martha Q.; Dispenzieri, Angela; Hayman, Suzanne R.; Kumar, Shaji K.; Gastineau, Dennis A.

doi:10.1182/blood.V108.11.2956.2956

INTRODUCTION

The use of growth factors filgrastim and sargramostim are associated with often dramatic degrees of fluid retention in patients with amyloidosis who have coexistent cardiac involvement or nephrotic syndrome. Significant degrees of fluid retention can complicate the post transplant management of patients with AL receiving high dose chemotherapy. We report outcomes in a cohort of amyloidosis patients who received no growth factor support post transplant.

PATIENTS AND METHODS

283 consecutive patients seen for stem cell transplant are included in this cohort. In order to be considered evaluable for engraftment the patient must have survived for 30 days or was excluded from analysis. All patients had biopsy verified AL. Patients also had to have visceral organ dysfunction in order to be eligible for stem cell transplant with a minimum of one visceral organ involved.

RESULTS

Among 283 patients transplanted, 244 were evaluable for engraftment. There were 145 men (59%). Renal involvement was present in 163 (67%), cardiac involvement by echocardiography in 47%, hepatic involvement in 16%, and peripheral nerve involvement in 11%. The median age was 56.6 years (range 33–73). The median time from diagnosis of amyloidosis to stem cell transplantation was 4.2 months. A neutrophil count of 500/uL was achieved in 50%, 75%, and 90% of the total group at 14, 16, and 22 days respectively (figure 1). A platelet count of 20,000/uL was achieved in 50%, 75%, and 90% of patients at 14, 19, and 28 days respectively (figure 2). A platelet count of 50,000/uL was achieved in 50%, 75%, and 90% of patients at 18, 28, and 52 days respectively. The median time spent in the hospital for the entire cohort 9 days. 46 of the patients (19%) completed the entire procedure as an outpatient. 75% of patients were discharged within 18 days and 90% were discharged within 32 days. 137 patients were blood culture negative throughout the entire procedure (56%). A blood culture was positive in the remaining 107 patients. 68 of these 107 contained a culture for Staph. coagulase negative. 39 (16%) had bacteremia associated with other organisms.

CONCLUSION

Transplantation of patients with amyloidosis without using growth factor is feasible. The median time to achieve neutrophil and platelet counts of 500 and 20,000/uL respectively is 14 days. It is reasonable to withhold growth factor from AL patients undergoing stem cell transplantation.