autologous blood and marrow transplantation - Blog Science ...

578 Chapter 10: Graft Manipulation
Table 5. Platelet engraftment: single reinfusion vs. split/delayed G-CSF
Single reinfusion Split/delayed G-CSF P value
Days platelets >20,000 22 ± 7.9 14 ± 1.8 0.0037
Days platelets >50,000 31 ± 14.6 18 ±2.5 0.0213
No. transfusions 4.2 ± 1.6 2.8 ±0.8 0.0046
toward faster recovery with fewer transfusions. Compared with a single infusion 24
hours after the first injection of G-CSF, platelet engraftment was significantly
improved (Table 6). These observations suggest a competition for stem cell differentiation
into myeloid and megakaryocyte lineages which can be shifted depending
on the scheduling of growth factors such as G-CSF.
We will continue to transplant PSC over 2 consecutive days but will delay G-
CSF only 24 hours after the last infusion in an effort to achieve a balance between
neutrophil and platelet recovery. Availability of additional cytokines, such as stem
cell factor, and modified forms, such as pegylated-erythropoietin, present the
challenge of combined or sequential use with G-CSF to optimize multilineage
engraftment after PSC transplant.
REFERENCES
1. Weaver CH, Hazelton B, Birch R, et al.: An analysis of the engraftment kinetics as a func­
tion of the CD34 content of peripheral blood progenitor cell collections in 692 patients
after administration of myeloablative chemotherapy. Blood 86:3961-3969, 1995.
2. To LB, Roberts MM, Haylock DN, et al: Comparison of hematological recovery times
and supportive care requirements of autologous recovery phase peripheral blood stem cell
transplants, autologous bone marrow transplants and allogeneic bone marrow transplants.
Bone Marrow Transplant 9:277-284, 1992.
Table 6. Summary of myeloid and platelet recovery
Single reinfusion,
G-CSF 24 hours before
Split reinfusion,
G-CSF 24 hours before
Split reinfusion,
G-CSF 48 hours after
Days
ANC Platelets
100 >500 >20,000 >50,000
5 11 13 22 31
3 9 11 17 21
5 10 11 14 18