autologous blood and marrow transplantation - Blog Science ...

576 Chapter 10: Graft Manipulation
Table 1. Neutrophil engraftment: single vs. split reinfusion
Single reinfusion Split reinfusion P value
Days ANC 100 11 ±2.5 9 ±0.8 0.0322
Days ANC >500 13 ±2.6 11 ± 1.2 0.0168
respectively (P=0.44). Administration of G-CSF 24 hours before transplant and
stem cell infusion over 2 days positively affected neutrophil engraftment (Table 1).
The number of neutropenic days was reduced, with significantly faster myeloid
engraftment. Although not statistically relevant, there was a trend toward faster
platelet recovery and fewer transfusions (Table 2).
In an effort to hasten platelet recovery, G-CSF administration was delayed to 48
hours after completion of the split transplant instead of 24 hours before reinfusion.
Results are summarized in Table 3 for platelet recovery and in Table 4 for
neutrophil recovery. There was a continued trend toward faster platelet recovery.
Conversely, the number of neutropenic days increased from 3 to 5 and initial
myeloid engraftment to > 100 was significantly delayed.
The combination of split infusion and delayed G-CSF hastened platelet
recovery (Table 5) compared with our original protocol, which initiated G-CSF 24
hours before a single infusion of stem cells. The improvement in platelet
engraftment to 20,000 and 50,000 was both statistically and clinically relevant, as
was the decrease in the number of platelet transfusions. Postponing the administration
of G-CSF did not negatively impact myeloid recovery or the number of
neutropenic days (Table 6) compared with the initial protocol of a single infusion
preceded by G-CSF.
DISCUSSION
The side effects associated with stem cell reinfusion can be more severe when
the cells derive from large-volume, hypercellular leukaphereses that require more
DMSO for adequate cryoprotection. Reinfusion of stem cells in two sessions on
consecutive days not only minimized the anticipated side effects but also had an
Table 2. Platelet engraftment: single vs. split reinfusion
Single reinfusion Split reinfusion P value
Days platelets >20,000 22 ± 7.9 17 ±5.9 0.1077
Days platelets >50,000 31 ± 14.6 21 ±8.6 0.0713
No. transfusions 4.2 ±1.6 3.0 ± 1.3 0.0678