scholarly journals Viral infections during CD34+ cells purified autologous peripheral blood stem cell transplantation for the treatment of refractory autoimmune diseases

2006 ◽  
Vol 12 (2) ◽  
pp. 91
Author(s):  
K. Nagafuji ◽  
H. Tsukamoto ◽  
A. Numata ◽  
T. Miyamoto ◽  
M. Harada
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autoimmune Diseases ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Viral Infections ◽  
Peripheral Blood Stem Cell ◽  
Blood Stem Cell ◽  
Cd34 Cells ◽  
Blood Stem Cell Transplantation

Impact of CD34+ Cell Dose in Peripheral Blood Stem Cell Transplantation from Unrelated Donors for Acute Leukemia Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2065-2065
Author(s):  
R. Marks ◽  
A. Spyridonidis ◽  
G. Ihorst ◽  
H. Bertz ◽  
J. Finke
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Hazard Ratio ◽  
Blood Stem Cell ◽  
Cd34 Cells ◽  
Unrelated Donors ◽  
Blood Stem Cell Transplantation

Abstract In a retrospective study we analysed the impact of the graft composition and several clinical criteria on the outcome of adult AML (n=104) and ALL (n=29) patients undergoing first allogeneic peripheral blood stem cell transplantation from unrelated donors at the University Hospital in Freiburg. The median age of the patients was 52 years (range 18–74) and of the donors 35 years (range 20–58). All patients above 55 years of age received a preparative regimen consisting of fludarabine, melphalan and carmustin (FBM) whereas patients <55y received standard busulphan and cyclophosphamide. Graft-versus-host disease (GvHD) prophylaxis consisted of rabbit ATG (40–60 mg/kg; Fresenius) and cyclosporine combined with MTX in BuCy treated patients or mycophenolate mofetil in patients treated with FBM. There was a trend in the younger donors to mobilize more CD34+ cells than older ones (r=−0.147, p=0.11). A median of 6.1x106 CD34+ cells/kg (range 1.5–17.0) and 3.1 x108CD3+ cells/kg (range 1.0–20.0) were infused. There was no association between the numbers of CD34+ and CD3+ cells in the transplanted peripheral blood stem cell graft (r=0.097, p=0.29). The dose of CD3+ cells infused correlated with the occurence of acute GvHD (aGvHD) II–IV (p=0.02) but not with the development of chronic GvHD (cGvHD). The risk of chronic or acute GvHD was not different between patients receiving more than the 75. percentile (p75) of CD34+ cells (>8x106cells/kg) compared to those receiving < p75 CD34+ cells. In multivariate analysis of all leukemia patients, acute GvHD, chronic GvHD and age were independent prognostic factors in OS. But in older patients (>50y), higher (>p75) CD34+ cell dose in the PB graft was associated with a trend to better OS at one year both in univariate (hazard ratio 0.508, 95% CI, 0.231 to 1.114, p=0.0908) and multivariate analysis (hazard ratio 0.521, 95% CI, 0.235 to 1.155, p=0.1084), while CD34+ cell dose did not have any impact in the OS of younger (<50y) patients. Univariate analysis of 104 patients with myeloid diseases revealed that patients sex, disease status at HCT, HLA match, or the preparative regimen (BuCy versus FBM) did not have any recognizable effect on OS, resulting in a 1-year survival of 65–70% in all analysed subgroups. Multivariate analysis showed that occurence of aGvHD was associated with significantly increased mortality in younger patients (BuCy treated, hazard ratio 3.287, 95% CI 1.126 to 9.596, p=0.03) as compared to FBM patients (hazard ratio 1.52, 95% CI 0.552 to 4.188, p=0.41). Relapse rates were lower in patients who experienced cGvHD as compared to those without cGvHD resulting in a significantly better OS (hazard ratio 0.276, 95%CI, 0.102 to 0.750, p=0.011). In conclusion the data show that in leukemia patients treated with peripheral blood stem cell transplantation from unrelated donors, older patients receiving grafts with higher CD34+ cell counts show a trend to better survival, while in the same group FBM conditioning does not increase the treatment related mortality.

Pegfilgrastrim Compared with Filgrastim after Autologous Hematopoietic Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5287-5287
Author(s):  
Gaetan Vanstraelen ◽  
Pascale Frère ◽  
Marie-Christine Ngirabacu ◽  
Evelyne Willems ◽  
Georges Fillet ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clinical Outcome ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Blood Stem Cell ◽  
Cell Counts ◽  
Cd34 Cells ◽  
Blood Stem Cell Transplantation

Abstract In order to assess the effect of Pegfilgrastim on the duration of neutropenia and clinical outcome of patients after autologous peripheral blood stem cell transplantation (PBSCT), we compared 20 consecutive patients with lymphoma or multiple myeloma receiving a single 6 mg dose of Pegfilgrastim on day 1 posttransplant to a historical control group of 60 patients receiving daily Filgrastim 5 μg/kg starting on day 1 posttransplant. There were 54 M and 26 F, 30 patients with lymphoma and 50 with myeloma, 26 in CR and 54 not in CR. Mean age was 55±10 yrs and 25 had already received a previous autologous transplant. The two groups were matched for disease and disease status, transplant number, age and sex. Cell dose infused tended to be higher in the Pegfilgrastim group (7.16±3.82 vs 10.03±6.25 x106 CD34+ cells/kg, p=0.0575). There were no differences (p&gt;0.05) in time to 0.5 (8 vs 9 days) or 1 (9 vs 9 days) x109/L neutrophils; to 1 % reticulocytes (13 vs 15 days) or 9 (12 vs 14 days) or 10 (30 vs 25 days) g/dL Hb; to 20 (9 vs 9 days) or 100 (20 vs 31 days) x 109/L platelets. The number of days with fever (2.7±2.3 vs 2.3±2.4 days), incidence of infections (all infections; bacteremia; bacterial, fungal or viral infections; FUO), duration of antibiotic therapy (8.7±5.9 vs 8.4±5.9 days), RBC (1.1±1.6 vs 0.9±1.6) and platelet (1.0±1.7 vs 1.2±1.8) transfusions, and time to hospital discharge (14.5±5.3 vs 15.4±5.8 days) were similar in the Pegfilgrastim compared to the Filgrastim group. However, after initial hematopoietic recovery, several differences between the groups became apparent, with the group always showing higher counts compared to the Filgrastim group (p values &lt;0.05 to &lt;0.001). Neutrophils remained significantly higher in the Pegfilgrastim group between days 14–30, lymphocytes between days 56–90, monocytes between days 21–24, reticulocytes between days 17–42 and platelets between days 35–90, respectively. These differences had no impact on clinical outcome after day 30 due to the low incidence of infectious events after engraftment. We conclude that Pegfilgrastim administrated on day 1 posttransplant facilitates early hematopoietic reconstitution comparable to daily Filgrastim. However, despite a trend towards fewer CD34+ cells transplanted, the Pegfilgrastim group enjoyed higher trilineage cell counts for some time after initial engraftment. This should be further tested in prospective randomized trials.

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