Autologous Bone Marrow Transplantation - Blog Science Connections

676 Transplantation of Circulating Stem Cells
plantations in seven adult patients with resistant ANLL. A rapid and sustained
erythroid and granulomonocytic engraftment was obtained in every case, but
megakaryocyte engraftment was observed in only five of the seven patients.
PATIENTS AND METHODS
PBSC Collection
Blood-derived stem cells were collected in seven adult ANLL patients
(mean age, 26 years [range, 15-48 years]; male:female ratio, 4:3). Leukaphereses
were performed during first CR (three patients), second CR (three
patients), or fourth CR (one patient) during marrow recovery following
chemotherapy given as induction treatment to five patients, and as consolidation
or intensification treatment of two patients. Five to seven leukaphereses
(median, 5.9 leukaphereses) per patient were done during a 12.7-day period
(range, 10-18 days); in six cases, a continuous flow cell separator (Cs 3000)
was used. A mean of 28.7 x 10 4
CFU-GM cells/kg per patient was collected.
Harvested cells were cryopreserved with dimethyl sulfoxide and stored in
liquid nitrogen according to previously described methods (9).
Autologous Transplantation
Patients underwent autologous PBSC transplantation during first relapse
(two patients), second CR (four patients), or fourth CR (one patient). The
median duration of CR before transplantation was 9 months (range, 2-40
months). Five patients were prepared with etoposide (VP-16-213, 300
mg/ m 2 / day i.v. for 2 days), cyclophosphamide (60 mg/kg/day i.v. for 2 days),
and total body irradiation (TBI, 5 Gy x 2 or 4 Gy x 3). Two patients received
busulfan (4 mg/kg/day per os for 4 days); in one of these patients this was
followed by cyclophosphamide (50 mg/kg/day i.v. for 4 days) and in the other
by melphalan (140 mg/m 2
i.v.). After this conditioning regimen, patients
received transfusions of all previously collected buffy coat cells—a median of
6.3 x 10 8 (range, 2.95-10 cells) thawed nucleated cells/kg containing a
median of 17.6 x 10 4
(range, 2.75-49.7 cells) CFO-GM cells/kg. These
numbers correspond to 85% and 66%, respectively, of nucleated and CFU-GM
cells collected.
RESULTS
Hematopoietic Recovery (Table 1)
In every patient, reticulocytes were present during the 3 weeks following
transplantation. Median times required to recover to 0.5 polymorphonuclear
cells (PMN) x 10 9 /' and to 10 9 leukocytes/1 were, respectively, 14.5 and 12.4
days. Patients who received autografts of more than 10 x 10 4
CFC1-GM cells/kg
recovered more rapidly than other patients, median time to reach 0.5 x 10 9
PMN/1 being, respectively, 12.2 and 17.7 days (P, NS).