12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
observed, as this was assessed by the determination of perforin and
granzyme A expression (intensity). NK and NKT cells immunophenotyping
of the CNKL patients, accompanied by clinical and laboratory features,
could help in the better definition of this haematological disorder.
0984
A NEW OPTION FOR AN ANCIENT DISEASE: ANGIOGENESIS THERAPY
BY BONE MARROW TRANSPLANTATION IN ARTERIAL LIMB ISCHAEMIA
J. Novoa, A. Medina, C. Gordillo
Ministry of Health, MONTEVIDEO, Uruguay
Background. therapeutic angiogenesis has recently been developed as
a new method of treatment for several ischaemic diseases; both experimentally
and clinically there are preliminary data suggesting that
implantation of bone marrow-mononuclear cells into ischaemic limbs
increases collateral vessels formation. Aims. to evaluate viability of the
therapeutic angiogenesis using hematopoyetic bone marrow progenitors
mobilized by G-CSF (granulocyte colony stimulating factor) and safety
of the procedure. Methods. 40 patients developing critical arterial limb
ischaemia (candidates to amputation) were included in this study (International
Working Party). 23 men and 17 women. Median age 65 years
old (44-86). Mobilized by filgrastim (Neupogen ® ) 5 µg/kg weight daily
(5 days). Bone marrow harvest at 5th day. Local anaesthesia was
employed in all the patients. Unmanipulated cells were injected in the
affected limb in 2 ml aliquots into the gastrocnemius muscle. All the
patients received injections unless in one limb. 1 patient received treatment
in both. Each patient was evaluated regularly for rest pain, amount
of required analgesia , healing of the ulcers, peack walking time, Doppler
and angiographic findings. The mean number of injected mononuclear
cells was 1,9×109 /kg. All the patients received low molecular weight
heparin (nadroparin, Fraxiparine ® ) 3800-5600 IU anti-Xa subcutaneously
, aspirin 81 mg and pentoxifiline 400 mg daily, as medical treatment
after the procedure for at least 60 to 90 days. A control population of 39
vascular patients affected by critical arterial limb isquemia was considered.
They don’t received angiogenic treatment, only the same medical
antithrombotic schedule described. Results. there were no secondary
effects for the mobilization or injection of cells in the 40 studied patients.
There were no dead patients secondary to the procedure. Moreover, in
30 patients with a median follow up of 24 months, 32 patients showed
an improvement of all parameters, mainly pain at rest, peack walking
time and skin trophic lesions. Two patients suffered amputation of the
affected extremity because obstruction of an old by-pass (5%). On the
control population, amputation of the affected extremity was necessary
in 34 of the 39 patients evaluated with medical treatment only (87,2%).
The statistical differences betwen the two groups were highly significant
in favor of the angiogenic group. They were evaluated by the chi
square test and log rank test (p