Granulocyte colony‐stimulating factor mobilized whole blood containing over 0·3 × 10⁶/kg CD34⁺ cells is a sufficient graft in autologous transplantation for relapsed non‐Hodgkin's lymphoma

Abstract

Summary. The feasibility of unprocessed, granulocyte colony-stimulating factor (G-CSF)-mobilized whole blood (WB) as an alternative stem cell source for autologous stem cell transplantation was studied. Forty-seven relapsed nonHodgkin's lymphoma (NHL) patients entered the study. After two or three ifosfamide, methotrexate and etoposide (IMVP) courses, 1 l of G-CSF-mobilized WB was collected and stored refrigerated for 72 h. Meanwhile, BAM conditioning was given: BCNU (carmustine) 300 mg/m 2 , highdose cytarabine 6000 mg/m 2 and melphalan 140 mg/m 2 . Toxicity, haematological recovery and survival were assessed and compared with peripheral blood stem cell transplantation (PBSCT) and bone marrow transplantation (BMT) reference groups. High-dose G-CSF (2 · 12 lg/kg/d) gave the best mobilization results. Haematological recovery was related to the WB CD34 + content. A CD34 + threshold of ‡ 0AE3 10 6 /kg, obtained in 90% of patients using highdose G-CSF, correlated with adequate recovery: absolute neutrophil count (ANC) > 0AE5 ·

In vitro safety profile of G–CSF‐mobilized whole blood after storage for 7 days in an infusable‐grade L15 medium

“…Accordingly, we found similar neutrophil recovery after either mobilized WB or PBPC support after a BEAM (carmustine, etoposide, cytarabine, and melphalan)‐like regimen despite a 10 to 20 times lower CD34+ cell dose in the mobilized WB group 8 . Still, better mobilization regimes 9‐11 are required to increase CD34+ cell numbers in order to extend the number of eligible patients and to improve platelet recovery, which was slightly delayed in the mobilized WB group in comparison with that in PBPC transplants 8 . Concerning the limited storage time of mobilized WB, we have recently demonstrated that prolonged storage of WB for 7 days is feasible at 22°C by using a calcium‐free Leibovitz's L15 medium as a supplement to the standard anticoagulant citrate 12 .…”

“…Considering the CD34+ cell dose, the generally accepted cell dose of >2.0 × 10 6 per kg may not be required for mobilized WB, as extensive apoptosis after cryopreservation reduces the transplanted CD34+ cell dose of leukapheresis components, whereas extensive apoptosis does not happen during liquid storage of mobilized WB 6,7 . Accordingly, we found similar neutrophil recovery after either mobilized WB or PBPC support after a BEAM (carmustine, etoposide, cytarabine, and melphalan)‐like regimen despite a 10 to 20 times lower CD34+ cell dose in the mobilized WB group 8 . Still, better mobilization regimes 9‐11 are required to increase CD34+ cell numbers in order to extend the number of eligible patients and to improve platelet recovery, which was slightly delayed in the mobilized WB group in comparison with that in PBPC transplants 8 .…”

“…During the last few years, more than 100 transplants of 1‐ to 3‐day stored refrigerated mobilized WB have been performed at our department without serious side‐effects 5,8 . In this study, several variables that may be associated with adverse clinical effects during return were determined in mobilized WB transplants before return and in test samples after prolonged storage.…”

Autologous hematopoietic stem cell transplantation in refractory celiac disease with aberrant T cells

“…The nadir leukocyte and platelet counts and the duration of leukopenia and thrombocytopenia were comparable to our experience in patients with non-Hodgkin lymphomas and multiple myeloma undergoing ASCT after a combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) or high-dose melphalan (HDM; 200 mg/m 2 ). 32 Because there is no standard conditioning regimen for ASCT used in autoimmune disease, 33 a standard regimen from our institution was used. Fludarabine induces T-cell depletion and the alkylating agent melphalan was used to achieve myeloablation.…”

Prediction of engraftment after autologous peripheral blood progenitor cell transplantation: CD34, colony‐forming unit–granulocyte‐macrophage, or both?

“…[1][2][3][4][5][6][7] In particular, a very low number of PBPCs will lead to delayed recovery of platelets (PLTs) and, to a much lesser degree, granulocytes. 1,2,4,8 Various measures have been used to document the concentration of PBPCs in PBPC products. A poor correlation was found between the total number of infused mononuclear cells and hematologic recovery.…”