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Centrifugal devices for donor plasmapheresis that collect platelets as a by-product have recently been introduced. The platelet yield ranges from 1.2 to 2 X 10(11) per collection, and the collection time exceeds 50 minutes. An attempt to increase yields and to reduce the procedure time was carried out at our center, taking advantage of the Dideco Eccentriplate (Dideco spa, Mirandola, Italy). Within 30 minutes, 510 ml of plasma were collected along with 3.3 X 10(11) platelets. The shift of donors from whole blood to plasma and platelet donation generated a progressive decrease in red-cell availability. In order to maintain plasma and platelet production without affecting the erythrocyte production, a technique was developed that allows the collection of 3.68 X 10(11) platelets, 250 ml of plasma, and 225 ml of packed red blood cells with a hematocrit of 66.5%. The mean procedure time was 31.6 minutes; 2,671 ml of blood were processed at flow rates of 85-100 ml/minute. The cellular cross contamination of the platelet concentrates was 1.76 X 10(8) (leukocytes) and 2.23 X 10(8) (erythrocytes). Although the procedure was carried out in a selected group of donors, the technical experience has strongly modified our procedure for platelet and plasma collection.

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Thirty patients with chronic granulocytic leukemia (CGL), were given cyclophosphamide 60 mg/kg on each of 2 consecutive days, followed by total body irradiation (TBI) 10 Gy and an HLA-identical bone marrow transplant (BMT). Eleven patients were in the accelerated phase of their disease (CGLacc) or in second/secondary chronic phase (CGL-2CP), with a median age of 33 years: four patients died of transplant related complications, and four of recurrent leukemia; three patients are alive and well 19, 31, 33 months from BMT. The actuarial 33-month survival is 27%. The actuarial relapse rate is 50%. Nineteen patients were in their first chronic phase (1CP), with a median age of 32 years: three died of graft versus host disease (GvHD), two of infection, and two of acute respiratory distress syndrome (ARDS); 12 are alive and well 6 to 29 months post-BMT. The actuarial 29-month survival is 63%. The actuarial survival of patients younger than 30 years is 63%, compared to 62% for patients older than 30 (P = 0.1). The survival of patients grafted within or after 24 months from the onset of CGL is respectively 87% and 45% (P = 0.04). None of the patients grafted in 1CP had a true hematologic-cytogenetic relapse. The Ph' chromosome was detected on one occasion in two patients 12, 13 months post-BMT: they both remain hematologically normal and Ph1-negative 3 to 6 months later, after discontinuation of cyclosporin A. This study confirms that survival exceeding 60% can be obtained in CGL in the first chronic phase, whereas less than 30% of patients will survive if grafted in accelerated, second/secondary chronic phase, mainly because of leukemic relapse. The duration of the disease seems to be relevant to the outcome of the transplant. The effect of post-transplant immunosuppression, in our case cyclosporin A, on the interaction between normal and Ph1-positive hemopoietic cells, may deserve further attention.

A 28-year-old woman with Bence-Jones multiple myeloma (MM) presented with several osteolytic lesions and a massive bone marrow infiltration with mature plasmocytes. After 6 cycles of chemotherapy with melphalan and prednisone, the patient, in apparent clinical remission, underwent allogeneic bone marrow transplantation (BMT) from her brother. The patient has been followed up for 23 months, showing complete remission by clinical and laboratory criteria. Other cases of MM treated with BMT and reported in the literature are reviewed and discussed.