Autologous Bone Marrow Transplantation - Blog Science Connections

688 Peripheral Blood Stem Cell Transplantation
facilitate bone marrow stem cell collections when feasible. In some cases,
however, extensive marrow contamination by tumor or prior radiotherapy limits
the availability of bone marrow stem cells. Also, in rare cases general or regional
anesthesia necessary for bone marrow stem cell harvesting is associated with
an unacceptable risk to the patient. Peripheral blood stem cells (PBSCs)
obtained by multiple leukapheresis circumvents the problem of availability and
may be associated with less frequent tumor cell contamination. The following
case and review are presented to illustrate several points regarding this
treatment.
MATERIALS AND METHODS
Using the IBM 2997 cell separator we collected stem cells eight separate
times from a patient with relapsed Hodgkin's disease. The initial two procedures
took 3 hours each, and the remaining six took a full 4 hours each. Most of the
procedures were performed using a Vascath central venous catheter (Gambro,
Lincolnshire, 1L) as access for both the draw and return lines. Flow rates and
centrifuge speeds were selected for optimum peripheral blood mononuclear
cell (PBMC) collection. These were a flow rate of 40 ml/minute with a centrifuge
speed of 938 rpm or a flow rate of 45 ml/minute with a centrifuge speed of 995
rpm. Collected volumes varied from 198 ml to 300 ml. The resulting cell
suspensions were adjusted to 10 U/ml with heparin before further processing.
The buffy coat was isolated from the cell suspensions and cryopreserved at
a concentration of 10 8 /ml using 10% dimethyl sulfoxide and 20% autologous
plasma from which cryoprecipitate was previously removed for freezing
medium as described elsewhere (2). Samples from each separate batch were
analyzed for granulocyte-macrophage colony-forming units (CFUs-GM) and
erythroid burst-forming units (BFUs-E) immediately and after thawing.
RESULTS
The patient, a 20-year-old man, initially presented with Hodgkin's disease,
stage IIIB. After initial complete remission after therapy with mechlorethamine,
Oncovin (vincristine), procarbazine, and prednisone combined with Adriamycin
(doxorubicin), bleomycin, vinblastine, and dacarbazine (MOPP-ABVD), he
relapsed on two subsequent occasions. His subsequent treatment involved
MOPP-ABVD, mantle radiation to 37 Gy, CCNU (lomustine), methotrexate,
etoposide, another series of MOPP-ABVD, and most recently cytarabine,
cisplatin, and dexamethasone.
In May 1986 high-dose chemotherapy with autologous bone marrow
transplantation was planned. Results of bilateral bone marrow biopsies were
negative for involvement with Hodgkin's disease, so multiple bone marrow
aspirations were performed with the patient under general anesthesia. Cells
were cryopreserved. In the course of this process, six separate iliac crest bone