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Peripheral blood progenitor cell transplantation in lymphoma and leukemia
using a single apheresis
R Pettengell, GR Morgenstern, PJ Woll, J Chang, M Rowlands, R Young, JA Radford, JH Scarffe, NG Testa and D Crowther
CRC Department of Medical Oncology, Christie Hospital NHS Trust,
Manchester, UK.
Myeloablative treatment and peripheral blood progenitor cell (PBPC)
transplantation are increasingly used for lymphomas and leukemias. We have
sought to optimize conditions for priming, collection, and engraftment of
the leukapheresis product. Fifty-four consecutive adult patients were
eligible, 31 with high-grade non-Hodgkin's lymphoma of poor prognosis, 12
with Hodgkin's disease in chemosensitive relapse, and 11 with poor
prognosis acute lymphoblastic leukemia. Filgrastim was administered after
routine chemotherapy with VAPEC-B or HiCCOM to mobilize PBPC. A rapidly
increasing white blood cell count was used to predict the time of peak PBPC
release and plan leukapheresis. Forty- five patients underwent
leukapheresis. A median of 14 L of blood was processed at a single
apheresis. A median of 2.4 x 10(8)/kg mononuclear cells (MNCs), 1.04 x
10(6)/kg granulocyte-macrophage colony-forming cells (GM-CFCs), and 10.6 x
10(6)/kg CD34+ cells were obtained. Slightly fewer MNCs were obtained from
the heavily pretreated Hodgkin's disease group. There were no other
significant differences in the size or composition of the leukapheresis
harvest in the three patient groups. Forty patients underwent high-dose
therapy and PBPC transplantation. Filgrastim was administered by daily
subcutaneous injection until the absolute neutrophil count was > or = 1
x 10(9)/L for 2 consecutive days. Rapid and sustained hematopoietic
engraftment occurred in all patients. The median time to achieve a
neutrophil count > or = 0.5 x 10(9)/L was 9 days (range, 8 to 16 days);
to achieve a platelet count > or = 20 x 10(9)/L was 10 days (range, 6 to
88 days); and to achieve a platelet count > or = 50 x 10(9)/L was 15.5
days (range, 10 to 100 days). Neutrophil recovery was faster than that of a
historical control group treated with autologous bone marrow
transplantation and filgrastim, but platelet recovery times were halved in
the PBPC group. There was no secondary engraftment failure. Requirements
for blood and platelet transfusions, antibiotic use, and parenteral
nutrition were similar in the three patient groups. The median number of
days in the hospital was 13 (range, 10 to 55) in the PBPC patients,
compared with 19 (range, 14 to 51) in the historical controls.
Leukapheresis yields (MNC, GM-CFC, and CD34+ cell numbers) were not useful
for predicting the times to engraftment. We have shown that sufficient PBPC
for transplantation can be obtained at a single leukapheresis after
mobilization with routine chemotherapy and filgrastim in patients with
non-Hodgkin's lymphoma, Hodgkin's disease, and acute lymphoblastic
leukemia, even those heavily pretreated.(ABSTRACT TRUNCATED AT 400 WORDS)
Volume 82,
Issue 12,
pp. 3770-3777,
12/15/1993
Copyright © 1993 by The American Society of Hematology
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