autologous blood and marrow transplantation - Blog Science ...

Neutrophils
Days 100
Days to >500
Platelets
Days to >20,000
Days to >50,000
# of transfusions
Dicke et al. 573
Split reinfusion,
Single reinfusion delayed G-CSF P value
5 ±2.5
11 ±2.5
13 ±2.6
22 ±7.9
31 ± 14.6
4.2 ± 1.6
5± 1.2
10 ±0.8
11 ±0.7
14 ± 1.8
18 ±2.5
2.8 ±0.8
0.4665
0.3144
0.0350
0.0037
0.0213
0.0046
Compared with the single reinfusion group, the first 17 patients receiving split
reinfusion/delayed G-CSF had significantly faster, more consistent platelet
recoveries with fewer transfusions. Delayed G-CSF saved approximately $2000.
Myeloid engraftment was postponed initially, but accelerated under the influence
of G-CSF; days to >500 was still significantly faster. Delays in early myeloid
recovery did not cause infectious complications; one of nine patients in the split
reinfusion group and one of 17 in the split reinfusion/delayed G-CSF group
required hospitalization.
INTRODUCTION
Hematopoietic recovery after high-dose chemotherapy and autologous
transplant depends on the source and quantity of CD34 +
progenitor cells reinfused.
Mobilized peripheral cells (PBSC) have virtually replaced bone marrow as the
source of progenitor cells because larger numbers of CD34 +
cells can be collected,
which engraft faster and reduce the morbidity and cost of transplant. 1
"* Several
groups, including our own, have demonstrated rapid, multilineage engraftment by
reinfusing 4-5 X10 6
CD34 +
cells/kg of body weight. 5-7
The side effects of
progenitor infusion such as chills, bronchospasm, shortness of breath, and fluid
overload can be worse with PBSC due to their larger volumes, more dimethylsulfoxide
(DMSO), and increased number of granulocytes. Cells could be processed
and volume reduced prior to transplant 8
or simply reinfused over 2 consecutive
days to minimize the side effects. The first 26 patients to receive split reinfusions
were compared with a historic group of 20 patients who had received their stem
cells in a single reinfusion. Patients receiving split reinfusions started their G-CSF
either 24 hours before the first infusion of cells or 48 hours after completion of
stem cell reinfusion to determine the effects on multilineage engraftment.