autologous blood and marrow transplantation - Blog Science ...

582 Chapter 10: Graft Manipulation
BM (i.e., BM harvested from individuals who are not receiving hematopoietic
growth factor therapy and who generally have not received any myelosuppressive
chemotherapy within the month or more before BM harvesting). From this
observation, we hypothesized that the accelerated engraftment associated with
PBSC is the result of the priming before stem cell harvesting and is not due to the
anatomic derivation of the stem cells. Alternatively stated, our hypothesis was that
BM harvested following a mobilizing treatment with cytokines should produce as
rapid a hematologic recovery as PBSC harvested following the same treatment.
Recently, Beyer et al. 19
and Schmitz et al. 20
have presented prospective,
randomized trials comparing resting BM with mobilized PBSC autologous
transplants. These authors observed more rapid recovery of both circulating
neutrophils (2 days and 1 day faster, respectively) and circulating platelets (7 days
faster in both trials) with the mobilized PBSC. Because the conditioning of the
patients before harvesting was different for BM collections (no conditioning) than
for PBSC collections (chemotherapy followed by G-CSF 19
or G-CSF administered
as a single agent for PBSC mobilization 20
), these results are not inconsistent with
our hypothesis.
To test our hypothesis, we have conducted a randomized, stratified, prospective
trial comparing blood- and marrow-derived stem cells harvested under identical
growth factor-stimulating conditions. The following is a report of our data
describing rates of posttransplant hematologic recovery and also the duration of
posttransplant disease-free survival.
MATERIALS AND METHODS
Patients
Beginning in June 1993, patients were recruited from our referred patient
population. To be eligible for this study, patients were required never to have had
evidence of their malignant disease in their bone marrow by histologic criteria and
could not have had a leukemic disorder. The majority of the patients in the trial had
either breast cancer or lymphoma (Table 1). Patients were informed of the trial and
gave written consent to participate, as approved by the Scientific Review
Committee of the H. Lee Moffitt Cancer Center and as approved and annually
reviewed by the Institutional Review Board of the University of South Florida.
Mobilization/priming, harvesting, and cryopreservation
Patients received G-CSF (filgrastim), 16 pg/kg intravenously per day for 9 days.
On day 6, BM was harvested, and on days 7 through 10, leukaphereses were