Mobilisation of healthy donors with lenograstim and transplantation of HLA-genoidentical blood progenitors in 54 patients with hematological malignancies: a pilot study

Abstract

Summary:Blood cell transplantation (BCT) is now common practice in the autologous setting. We performed a pilot study of allogeneic BCT, collected after the priming of an HLA-identical sibling with a glycosylated rhu-G-CSF (lenograstim) (10 g/kg). genitors allows easy harvest with cytapheresis, and collection of a better quality graft than after traditional BM harvest.2 In the autologous setting, this effectively leads to faster neutropenic reconstitution but also to accelerated platelet reconstitution. This quicker hematopoietic recovery resulted in decreased transplant-related morbidity, shorter duration of hospitalization and reduced transfusion requirement.3,4 Associated with a reduction in procedural cost this motivated physicians to consider autologous transplantation for a larger number of patients. The shift from BM to blood cell (BC) transplantation occurred within a few years and coincided with a rapid increase in the number of autologous transplants world-wide. 5 The rapid development of autologous BC transplantation (BCT) provided the necessary experience and led to modification of the procedure for the allogeneic setting. In this situation, early interest arose for the same reasons as in the autologous situation: harvesting cells easily and without general anesthesia from normal donors, infusing more progenitors and so potentially decreasing morbidity and costs. The main expectation, in this setting, remains that the change in technology will induce a substantial decrease in transplant-related toxicity.

Higher doses of CD34+ peripheral blood stem cells are associated with increased mortality from chronic graft-versus-host disease after allogeneic HLA-identical sibling transplantation

“…41,42 Moreover, a minimal CD34+ cell dose was shown necessary for engraftment in autologous PBSC transplantation. 43 In the current study, as has been suggested by our previous work, 23 an increased allogeneic CD34+ cell dose leads to a faster neutrophil and platelet engraftment. This observation is supported by other studies.…”

“…These patients were included in two consecutive trials by the SFGM-TC teams and were previously reported for other purposes. 11,23 The majority of the patients included in this analysis (n ¼ 59) were treated at the Marseille, Montpellier, and Lyon transplantation centers. Written informed consent was obtained from each patient and donor.…”

A randomised study of allogeneic transplantation with stem cells from blood or bone marrow

“…steroids. Other studies have revealed a slightly shorter hospital stay, 13,36 but readmission seems to be more frequent among the PBPC recipients. A short hospital stay is important for the patients and their families, and could also have economic implications, an issue, which is not estimated in our study.…”

Healthy sibling donor anxiety and pain during bone marrow or peripheral blood stem cell harvesting for allogeneic transplantation: results of a randomised study

“…In the BM group, not surprisingly, the maximum pain experienced by donors followed the surgery itself when donors recover from general anesthaesia. Although a lot of clinical studies had already reported on the toxicity of G-CSF for healthy donors, [13][14][15][16] none had evaluated the impact of G-CSF stimulation on subjective well-being. Our study confirms that G-CSF stimulation is the most painful part of the harvesting procedure for BC donors and cytapheresis generated only moderate pain.…”