FAILURE TO ENGRAFT AFTER BONE-MARROW TRANSPLANTATION - BONE-MARROW MORPHOLOGIC FINDINGS

Few studies have explored bone marrow findings in patients with graft failure or delayed engraftment after bone marrow transplantation (BMT) . The authors retrospectively identified 4 patients of 165 transplant recipients who underwent bone marrow examination after BMT because per ipheral blood counts had not recovered to expected levels. All patient s were women who were 21- to 19-years old (mean 37 years). Three patie nts underwent autologous BMT; the fourth received peripheral stem cell infusion. Transplants were performed for treatment of Hodgkin's disea se, breast carcinoma, and follicular small cleaved cell lymphoma. Thre e patients received GM-CSF after marrow infusion. The time between tra nsplant and biopsy ranged from 19 to 40 days (mean 22 days). White cel l counts ranged from 0.1 to 0.6 X 10(9)/L, hematocrits from .25 to .41 , and platelet counts from 10 X 10(9)/L to 39 X 10(9)/L. Aspirate smea rs were markedly hypocellular in all cases, and contained primarily st romal cells. Clot sections and core biopsies were markedly hypocellula r, and all contained histiocytes with foamy eosinophilic cytoplasm dif fusely throughout the biopsy. Acid-fast and Gomori's methenamine-silve r (GMS) stains were negative. Serous fat atrophy and marrow fibrosis w ere not seen. Delayed engraftment after BMT may be associated with a p rofuse histiocytic proliferation similar to that seen in immunodeficie ncy, some hematologic disorders, and storage diseases.