Response to Cyclosporine & Eltrombopag in Primary Graft Failure after Autologous transplant in Myeloma.

Primary graft failure is an uncommon but serious complication that occurs when the hematopoietic engraftment fails to occur within the expected timeframe. Here, we report the case of a 63-year-old female with multiple myeloma who developed primary graft failure after Autologous stem cell transplant (ASCT). Despite initial concerns regarding his poor prognosis, the patient was successfully treated with cyclosporine as a novel rescue therapy. This condition necessitates prolonged hospitalization, frequent transfusions, and poses a high risk of life-threatening infections due to persistent cytopenias. The incidence of primary graft failure in myeloma patients undergoing ASCT has been reported to be less than 1% in recent studies. Despite its low occurrence, the clinical consequences of this complication are profound, contributing significantly to morbidity and mortality in this patient population. Cyclosporine has emerged as a promising therapeutic agent for the management of primary graft failure. The mechanism of action is believed to involve immunosuppression. This case underscores the potential utility of cyclosporine as a therapeutic option in patients with primary graft failure following ASCT, offering an alternative to the more invasive and risky strategy of allogeneic stem cell transplant.