Autologous Bone Marrow Transplantation - Blog Science Connections

Peripheral Stem Cell Transplantation 619
leukaphereses were performed 4-7 weeks after the end of the fourth block of
VAIA.
Patient 5, who had recurrent Hodgkin's disease, was pretreated with
radiation and polychemotherapy—six courses of COPP and five of ABVD. A
total of 14 aphereses were performed during the third remission, six runs 2-5
weeks after a course of cyclophosphamide (15 mg/kg x 4 days) and another
eight runs 4 months later without intermittent chemotherapy.
Patient 6, who had newly diagnosed AML, was treated with two courses of
TAD within 4 weeks. Ten aphereses were performed early in the first
remission, 2-7 weeks after completion of the second TAD cycle.
Patient 7 had rhabdomyosarcoma and was pretreated with polychemotherapy—two
courses of VAIA and two courses of cisplatin (Platinex),
ifosfamide, Adriamycin, and vincristine (PIAV). A total of 10 leukaphereses
was performed, six runs 2-5 weeks after a course of cyclophosphamide (15
mg/kg x 4 days) and another four runs 4 months later without further
chemotherapy.
The number of leukaphereses and the cell yield per run is shown in Table
1 for each of the seven patients. The highest total stem cell number was
reached in patient 1: 15.1 x 10 6
granulocyte-macrophage colony-forming
units (CFU-GM);the lowest was in patient4 (a 9-year-old boy weighing 25 kg):
0.25 x 106 CFCI-GM.
Stem Cell Yield in Heavily Pretreated Patients After
Cyclophosphamide Treatment
In nine heavily pretreated patients, aphereses were performed after a
course of cyclophosphamide (15 mg/kg x 4 days). Five of them had endstage
Hodgkin's disease and were pretreated at least with cyclophosphamide,
mechlorethamine, Oncovin, procarbazine, and prednisone (C-MOPP) and
ABVD. One patient with rhabdomyosarcoma received prior polychemotherapy
(2 x VAIA and 2 x PIAV). These patients underwent a total of 37
aphereses. The average harvest per run was 3.1 x 10 4
CFU-GM. Three
patients with non-Hodgkin's lymphoma who had been pretreated with
standard multiple chemotherapy underwent a total of 16 apheresis runs. The
average number of cells harvested per run in those patients was 10.4 x 10 4
CFCI-GM.
Figure 1 diagrams the stem cell yield per run following treatment with
cyclophosphamide (15 mg/kg x 4 days). Stem cell apheresis was started 2-3
weeks after cyclophosphamide treatment. Usually six to eight runs were
performed overa period of 2-3 weeks. As one can see, in this group of heavily
pretreated patients, prior cytotoxic treatment with cyclophosphamide did not
result in a subsequent CFU-GM overshooting as occurred in patients in early
remission (25-32). The most probable explanation is an exhaustion of the
mobi lizable progenitor-cell pool by heavy and prolonged cytotoxic treatment.