VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

Interestingly, patients autografted with > 5 x 10 6
/kg CD34+ cells reached an
unsubstituted platelet count of >20 x 10V1 within a median time of only 10 days
(6-13). The treatment-related toxicity was moderate, reflected by a median duration
of fever > 38.5°C of only 3 days (1-14). The hospital stay following
autografting was 24.5 days (17-47). At the time of writing, 4 patients had relapsed
after a median time of 64.5 days (51 -141). Seventeen patients are alive
with a median event-free survival of 3 months (1-12).
DISCUSSION AND CONCLUSION
Blood-derived hemopoietic progenitor cells can be successfully mobilized
by G-CSF either administered during steady-state hematopoiesis or following
cytotoxic chemotherapy. 2
" 4
We found that the G-CSF-related mobilization capacity
was higher during chemotherapy induced marrow recovery resulting in substantial
rebound levels of CFU-GM and BFU-E as well as CD34+ cells.
In order to harvest sufficient quantities of hematopoietic progenitor cells as
soon as a distinct population of CD34+ cells is detectable in the PB, monitoring
of blood stem cell collection was performed according to the level of circulating
CD34+ cells. Analyzing factors associated with a low increase of circulating
CD34+ cells, the amount of previous chemotherapy was of major importance. A
similar finding has been reported by Brugger et al. 6
Patients with autografts containing
more than 5 x 10 6
/kg CD34+ cells had significantly less cycles of previous
chemotherapy. This finding is of clinical relevance because patients eligible
for high-dose therapy and PBSC autografting should be identified as early as
possible during the course of their disease to ensure blood stem cell harvesting
before hematopoiesis is compromized by multiple cycles of chemotherapy.
Following high-dose conditioning therapy, including two TBI-containing
regimens which are considered as myeloablative 7
, the G-CSF-exposed blood
stem cells were capable of restoring hematopoiesis. In patients autografted with
more than 5 x lOVkg CD34+ cells, platelet recovery was observed after a median
time of only 10 days. The kinetics of hematological reconstitution in our patients
exclusively reflect the restorative capacity of the blood stem cell autografts, because
no additional bone marrow support or hematopoietic growth factors were
given post-transplantation.
LITERATURE
1. Kessinger A, Armitage JO (1991) The evolving role of autologous peripheral stem
cell transplantation following high-dose therapy for malignancies. Blood 77:211.
2. Duhrsen U, Villeval J-L, Boyd J, et al. (1988) Effects of recombinant human granulocyte
colony-stimulating factor on hematopoietic progenitor cells in cancer patients.
Blood 72: 2074.
3. Demuynck H, Pettengell R, de Campos E, et al. (1992) The capacity of peripheral
blood stem cells mobilized with chemotherapy plus G-CSF to repopulate irradiated
marrow stroma in vitro is similar to that of bone marrow. Eur J Cancer 28:381
4. Haas R, Ho AD, Bredthauer U, et al. (1990) Successful autologous transplantation of
blood stem cells mobilized with recombinant human granulocyte-macrophage
colony-stimulating factor. Exp Hematol 18:94
5. Sheridan WP, Begley CG, Juttner CA, et al. (1992) Effect of peripheral-blood progenitor
cells mobilized by filgrastim (G-CSF) on platelet recovery after high-dose
chemotherapy. The Lancet 339:640.
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 235