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Myeloablative chemoradiotherapy and autologous bone marrow infusions for
treatment of neuroblastoma: factors influencing engraftment
J Graham-Pole, A Gee, S Emerson, J Gallo, C Lee, J Luzins, WE Janssen, T Pick, D Worthington-White and G Elfenbein
Department of Pediatrics, University of Florida College of Medicine,
Gainesville.
Bone marrow harvested from cancer patients for autologous bone marrow
reinfusion (ABMR) after myeloablative treatment may be injured, in both its
proliferating and stromal cell pools, by either previous treatment or
manipulation at the time of harvest. We have examined the relative effects
of seven covariates on hematologic recovery after ABMR in children with
neuroblastoma (NBL) using univariate and step-up analysis. We measured
recovery by times to achieve (1) white blood cell counts greater than
1,000/microL; (2) absolute neutrophil counts greater than 500/microL; and
(3) platelet counts greater than 20,000/microL without transfusion. In
univariate analysis, recovery was significantly associated with the amount
of prior chemotherapy and the interval between last chemotherapy and marrow
harvest. Patient sex, the number of granulocyte-macrophage colonies
infused, harvest-to-freeze interval, and use of purging were marginally
associated. After adjusting for potential confounders in a multivariate
model, the amounts of chemotherapy and granulocyte-macrophage colonies
infused were independently significant predictors of time to total white
blood cell count recovery; chemotherapy courses and chemo-to-harvest
interval were predictors of neutrophil count recovery; and sex, use of
purging, and harvest-to-freeze interval were marginal predictors of
platelet recovery. The speed of hematologic recovery after ABMR seems to
depend mainly on pre-existing factors and marginally on manipulation of the
marrow after harvest. These factors may affect both proliferating and
stromal cell pools.
Volume 78,
Issue 6,
pp. 1607-1614,
09/15/1991
Copyright © 1991 by The American Society of Hematology
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