Secondary poor graft function after autologous stem cell transplantation in multiple myeloma: a case-based expert review and successful rescue with secondary autologous stem cell infusion.
Jiawen You, Yuanyuan Zhang, Yuan Meng et al.
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Case in brief
A 59-year-old woman with IgG κ multiple myeloma initially achieved neutrophil and platelet engraftment after autologous hematopoietic stem-cell transplantation, but later developed recurrent transfusion-dependent pancytopenia. Evaluation excluded relapse, infection or viral reactivation, immune cytopenia, nutritional deficiency, and drug-related myelosuppression, supporting secondary poor graft function. Growth factors and thrombopoietin-receptor agonists helped only transiently. Infusion of cryopreserved autologous peripheral blood stem cells without re-conditioning was followed by platelet recovery within 7 days and durable recovery of all three blood-cell lineages.
What made this case unusual
Poor graft function emerged after initially timely engraftment, and an unconditioned infusion of the patient’s cryopreserved stem cells was followed by rapid platelet recovery and durable trilineage hematopoiesis.
Diagnostic / clinical pearl
Recurrent pancytopenia after initial engraftment warrants evaluation for secondary poor graft function after excluding relapse, infection, immune causes, nutritional deficiency, and drug-related suppression.
Why it matters
The case supports considering an unconditioned autologous stem-cell boost when reversible causes have been excluded and backup cells are available.