Use of G‐CSF alone to mobilize peripheral blood stem cells for collection from children

Summary:ings is unknown at present, some centers currently prefer to transplant these patients with PBSCs that have been depleted of potentially contaminating tumor cells. One To evaluate the feasibility and efficacy of CD34 ؉ cell immunoselection from routine peripheral blood stem possible method of reducing tumor cell contamination of the PBSC preparations is the positive selection of CD34 ϩ cell (PBSC) harvests in very small children a prospective study was performed in 15 children with advanced hematopoietic progenitor cells. 3 Initial trials of autografts with CD34 ϩ PBSCs have mainly been performed in adult neuroblastoma weighing 20 kg or less. Products of two consecutive leukaphereses carried out on a COBE Specpatients 4-6 and, outside of our team, 7 and so thus far there have been no reports of studies performed in small children. tra separator after G-CSF alone mobilization were pooled for immunoselection on Ceprate column. TheThe principal reasons for the restriction in the use of this technique in children with low body mass are PBSC collecmedian number of CD34 ؉ cells and total CFU-GM collected were respectively 5.9 ؋ 10 6 /kg (range 2.3-23.4) tion-associated difficulties (venous access, flow rate, metabolic and hemodynamic problems). In particular, when and 126.9 ؋ 10 4 /kg (range 52.9-559.9). After separation the median number of CD34 ؉ cells in the adsorbed fraclarge-scale collection is planned, which may require the processing of a considerable number of blood volumes, the tion was 2.6 ؋ 10 6 /kg (range 1-9.8) with a median purity of 54% (range 21-82) and a median of 95.7-fold safety of the procedure is of special importance. [8][9][10][11][12][13] We report the results of a prospective study designed to (range 35-250) enrichment. Thirteen patients underwent autografts with CD34 ؉ PBSCs after a busuldetermine whether sufficient numbers of CD34 ϩ cells can be obtained to provide reliable post-graft hematopoietic fan 600 mg/m 2 ؉ melphalan 180 mg/m 2 preparative regimen. The median number of days to achieve an reconstitution in very small children, after positive immunoselection of routinely collected leukaphereses products. absolute granulocyte count of 0.5 ؋ 10 9 /l and a platelet count of 20 ؋ 10 9 /l were respectively, 12 (range 10-24)We have investigated the feasibility and efficacy of this technique using the avidin-immunoaffinity column device and 35 (range 25-43). The median number of platelet transfusions was nine (range 2-15). We conclude that (Ceprate Stem Cell Concentrator; CellPro, Bothell, WA, USA) in 15 children with advanced neuroblastoma. These safe and effective immunoselection and transplantation of CD34 ؉ PBSC can be accomplished in children with patients may theoretically benefit from the isolation of CD34 ϩ hematopoietic progenitors, since the target CD34 low body mass.

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Feasibility of a PB CD34+ cell transplantation procedure using standard leukapheresis products in very small children

Berger¹,

Kanold²,

Rapatel³

et al. 1997

“…(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) dose myeloablative therapy in children with malignant disease has been shown to be effective and safe in childen. 1,2 Diagnosis (%) ALL 9 (16.07) Today the indications are largely clear, but there are contro- ANLL 5 (8.92) versies about collection and mobilization in children.…”

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confidence: 99%

“…1,2 Diagnosis (%) ALL 9 (16.07) Today the indications are largely clear, but there are contro- ANLL 5 (8.92) versies about collection and mobilization in children. 3,4 non-Hodgkin's lymphoma 6 (10.71) Moreover, although the PBSCT procedure is now routinely…”

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confidence: 99%

Non-tunneled catheters for the collection and transplantation of peripheral blood stem cells in children

Madero

Díaz

Benito

et al. 1997

Summary:patients, vascular access problems and low volume of blood are important factors. 7 The collection of PBSC requires venous access which We analyzed the use of non-tunneled (polyurethane, double lumen) central venous catheters (CVCs) for the ensures withdrawal and reinfusion of blood at high flow rates and allows repeated leukapheresis. Here, we analyze our experience of collection procedures following administration of granulocyte colonystimulating factor (G-CSF) using a continuous flow performed with non-tunneled catheters in pediatric patients. These catheters were used for collection, during conditionblood cell separator (Cobe Spectra). The mean TBV (total blood volume) processed was 4.5 ؎ 1. We reviewed 56 pediatric patients (36 males and 20 s.d. × 10 6 /kg (range 1-42), respectively. We observed the females) with various malignancies undergoing 71 leukafollowing complications during catheter insertion for pheresis sessions, from November 1993 until May 1996. collection: pneumothorax (1.7%), mechanical dysfunc-The mean age was 7.8 Ϯ 4.4 s.d. years (range 1-16) and tion (3.5%) that resolved with thrombolytic therapy.the mean body weight 30.7 Ϯ 15.7 s.d. kg (range 9-62). Complications during conditioning, transplantation andPatients had the following diagnoses: nine acute lymphoblimmediate post-transplantation periods were entry site astic leukemia (ALL), five acute non-lymphoblastic leukeinfection in five patients (8.92%), catheter-related infecmia (ANLL), six non-Hodgkin's lymphoma (NHL), three tion in two (3.57%) and catheter-related sepsis in three Hodgkin's disease (HD), 10 rhabdomyosarcoma, seven (5.35%). Our results indicate that the collection of neuroblastoma, five Ewing's sarcoma, one Wilm's tumor PBSC with non-tunneled catheters is safe, effective and and 10 central nervous system tumors. Parents and patients is associated with a low incidence of complications.were provided with information concerning the procedure.

“…1,2 Peripheral blood mononuclear cells (PBMC) that have been stimulated with G-CSF contain a small fraction of haematopoietic CD34 + stem cells 3,4 which are able successfully to restore haematopoiesis after myeloablative HD-CTX. 5,6 The success of such treatment, however, may be hampered by a contamination of the leukapheresis product with residual circulating tumour cells.…”

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confidence: 99%

Effective T cell regeneration following high-dose chemotherapy rescued with CD34+ cell enriched peripheral blood progenitor cells in children

Heitger

Kern

Mayerl

et al. 1999

Summary:The ex vivo enrichment for the CD34 ؉ cell fraction of PBPC, while it retains the capacity to restore haematopoiesis and potentially reduces a contamination by tumour cells, implements a depletion of T cells. To test whether such a setting adversely affects T cell reconstitution, we monitored T cells in four paediatric patients after CD34 ؉ selected PBPC transplantation. The dose of CD34 ؉ cells, which were enriched to 74%, median, was 7.1 ؋ 10 6 /kg, median, that of T cells was 0.071 ؋ 10 6 /kg, median. The patients were homogenous with respect to features with a potential to effect T cell reconstitution (low median age,