Description of Event or Problem · 1
FAILURE TO ENGRAFT. THE PT UNDERWENT A BONE MARROW TRANSPLANTATION FROM A MATCHED UNRELATED DONOR IN 1999. PER PROTOCOL, THE PT RECEIVED BUSULFAN AND CYCLOPHOSPHAMIDE AS THE CHEMOTHERAPY PREPARATIVE REGIMEN, FOLLOWED BY THE IMMUNOSUPPRESSIVE THERAPY OF CYCLOSPORINE A AND METHYLPREDNISOLONE. THE GRAFT COMPOSITION OF CD34 WAS WITHIN NORMAL LIMITS. ALTHOUGH THE PT DID NOT HAVE ANY SIGNIFICANT POSITIVE CULTURES NOTED, A CT SCAN ON 11/26/99 SHOWED "DIFFUSE PATCHY INFILTRATES, INFILTRATES THAT ARE ILL DEFINED AND SUGGEST A FUNGAL ETIOLOGY." THE PT REQUIRED MECHANICAL VENTILATION ON 11/27/99. ON DAY 26 POST TRANSPLANT, DECEMBER 14TH, A BONE MARROW BIOPSY WAS DONE. THE RESULTS SHOWED "VIRTUALLY ACELLULAR MARROW WITH FIBROBLASTS, LYMPHOCYTES, HISTIOCYTES, AND VERY RARE HEMATOPOIETIC PROGENITOR CELLS." A DECISION TO WITHDRAW CARE WAS MADE SECONDARY TO PROGRESSING RESPIRATORY SYMPTOMS WITH A PULMONARY HEMORRHAGE, MULTI-ORGAN FAILURE, AND GRAFT FAILURE. THE PT EXPIRED 27 DAYS POST TRANSPLANT. GRAFT FAILURE IS A WELL-KNOWN COMPLICATION OF BONE MARROW TRANSPLANTATION FROM UNRELATED DONORS. THE PRECISE ETIOLOGY OF SUCH GRAFT FAILURES IS UNCLEAR. ONE KNOWN RISK FACTOR IS THE MISMATCH AT HLA-C, WHICH WAS NOT THE CASE IN THIS PT. THERE HAVE BEEN TWO GRAFT FAILURES IN THE FIRST SEVENTEEN PTS ON THIS PROTOCOL (11%), WHICH IS THE INCIDENCE OF GRAFT FAILURE COMMONLY SEEN IN THIS SETTING NATIONALLY. THIS RISK FACTOR IS STATED IN THE CURRENT CONSENT FORM.