autologous blood and marrow transplantation - Blog Science ...

Fassas et al.
Table 2. Stem cell mobilization and toxicity
Mobilization
Trial 1 Trial 2
CY 4 g/m 2 4 g/m 2
G-CSF 5 ug/kg 10 ug/kg
GM-CSF 5 ug/kg
Toxicity 7/15 patients 5/9 patients
Allergy 4 (CY, GM-CSF)
Fever 2(grade 2)
Bronchial spasm 1 (grade 3)
Hypotension 1 (grade 4)
Oral 3 (grade 1)
Infections 9 4
Fever 8 (grade 2) 3(grade 2)
Bleeding 1 (grade 3)
UTI 1 (grade 1) 1 (grade 1)
Herpes
Epileptic seizure
455
1 (grade 1)
to conform to the guidelines of the EBMT/EULAR Consensus 15
(Table 2). There
were no failures of mobilization. The time from mobilization to transplantation
ranged from 16 to 52 days (median, 33) in trial 1 and 29 to 156 days (median, 81)
in trial 2. In the latter, CD34 +
cell selection of the graft was performed on the
Seprate SC System (CellPro). The procedure resulted in 3- and 1.8-log reductions
of CD3 +
and CD20 +
cells, respectively.
Transplant procedure
The BEAM regimen was administered for conditioning in both trials, at doses
used in SCT for lymphomas: BCNU 300 mg/m 2
on day -6, etoposide 200 mg/m 2
on days -5 to -2, cytosine arabinoside 200 mg/m 2
on days -5 to -2, melphalan 140
mg/m 2
on day -1. The infused doses of the CD34 +
cells/kg were 11.6X10 6
(±1.2)
and 3.8X10 6
(±1) in trials 1 and 2, respectively. The respective doses of CD3 +
cells/kg were 96.8X10 6
(±27) and 0.07 X10 6
(±0.04). In trial 2, the mean dose of
CD20 +
cells/kg was 0.12X10 6
(±0.08).
On days 1 and 2, to deplete lymphocytes in vivo, rabbit ATG (thymoglobulin;
Merieux) or horse ATG (Atgam; Upjohn) was administered at a total dose of onethird
the recommended dose for treatment of aplastic anemia; i.e., patients received
10 mg/kg or 60 mg/kg over 2 days, respectively. Soluble methylprednisolone (S-
M, 0.5 g/d) was also given with ATG to prevent adverse manifestations due to
cytokine release. As described previously, 14
for prevention of infection the patients
1