autologous blood and marrow transplantation - Blog Science ...

Gorin
TC 199 medium and finally frozen with 10% dimethylsulfoxide in Teflon-Kapton
DF 1000 Gambro bags (Gambro Dialysatoren, GMBH, Germany), following our
freezing technique as previously published. The purged BM was then stored in the
gas phase of liquid nitrogen at a temperature constantly below -190°C. 36
counts and CFU-GM evaluations were performed at all steps of the procedures.
The numbers of residual progenitor cells after incubation with mafosfamide were
known for each individual patient before autoBMT. To evaluate the cryopreser-
vation efficiency, a small aliquot of unpurged marrow was frozen in parallel with
the purged marrow and thawed 48 hours later. The cryopreservation efficiency was
expressed as the CFU-GM percentage recovery.
High-dose consolidation and transplantation
The standard regimen for consolidation combined cyclophosphamide (CY) (60
mg/kg for two doses along with 2-mercaptoethane, sodium sulfate at 60% of the
dose of CY) and total body irradiation (TBI). It was used in 190 patients.
Patients with contraindications for CY + TBI (>55 years old, poor cardiac
function by echography and isotopic evaluation of ejection fraction) received
alternative pretransplant regimens: 22 received the BAVC combination consisting
of BCNU 800 mg/m 2
, M-AMSA and VP16 450 mg/m 2
arabinoside 900 mg/m 2
.
RESULTS
Engraffment
493
Cell
each, and cytosine
The median time to recovery of polymorphonuclear cells (PMN) to 500/mm 3
was 27 days (10-153). The median time to recovery of platelets to 50,000/mm 3
was
63 days (15-1054). Variables possibly linked to faster engraftment as identified in
univariate analyses included characteristics of the patient and the disease—younger
age, diagnosis of ALL, transplant in CR1 (Figs. 1 and 2)—and characteristics of the
graft—richer marrow as evaluated pre- but not postpurging, better cryopreservation
efficiency. Regarding mafosfamide purging, the adjusted dose technique and a
higher (and not a lower) dose of mafosfamide for purging appeared possibly
associated to faster engraftment; this last observation concerned both the global
population of patients, with the two purging techniques combined (Table 1), and
the population of patients treated according to the AD technique only (Table 2).
After inclusion of these variables in the Cox proportional hazard model, factors
found to significantly influence the speed of engraftment (Table 3) were as follows:
7) Initial diagnosis: patients with ALL engrafted significantly more rapidly than
patients with AML (Table 4). Recovery of PMN in ALL was 20 days (13-136) vs.