Transplantation of allogeneic peripheral blood stem cells

Granulocyte colony stimulating factor expands hematopoietic stem cells within the central but not endosteal bone marrow region

Granulocyte colony stimulating factor (G-CSF) is clinically well established for the mobilization of hematopoietic stem cells (HSC). Extensive data on the underlying mechanism of G-CSF induced mobilization is available; however, little is known regarding the functional effect of G-CSF on HSC within the bone marrow (BM). In this study we analyzed the proportion and number of murine HSC in the endosteal and central bone marrow regions after 4 days of G-CSF administration. We demonstrate that the number of HSC, defined as CD150(+)CD48(-)LSK cells (LSKSLAM cells), increased within the central BM region in response to G-CSF, but not within the endosteal BM region. In addition the level of CD150 and CD48 expression also increased on cells isolated from both regions. We further showed that G-CSF mobilized proportionally fewer LSKSLAM compared to LSK cells, mobilized LSKSLAM had colony forming potential and the presence of these cells can be used as a measure for mobilization efficiency. Together we provide evidence that HSC in the BM respond differently to G-CSF and this is dependent on their location. These findings will be valuable in developing new agents which specifically mobilize HSC from the endosteal BM region, which we have previously demonstrated to have significantly greater hematopoietic potential compared to their phenotypically identical counterparts located in other regions of the BM.

Activation of Wnt signaling in hematopoietic regeneration

Hematopoietic stem cells (HSCs) respond to injury by rapidly proliferating and regenerating the hematopoietic system. Little is known about the intracellular programs that are activated within HSCs during this regenerative process and how this response may be influenced by alterations in signals from the injured microenvironment. Here we have examined the regenerating microenvironment and find that following injury it has an enhanced ability to support HSCs. During this regenerative phase, both hematopoietic and stromal cell elements within the bone marrow microenvironment show increased expression of Wnt10b, which can function to enhance growth of hematopoietic precursors. In addition, regenerating HSCs show increased activation of Wnt signaling, suggesting that microenvironmental changes in Wnt expression after injury may be integrated with the responses of the hematopoietic progenitors. Cumulatively, our data reveal that growth signals in the hematopoietic system are re-activated during injury, and provide novel insight into the influence of the microenvironment during regeneration.

Immature monocytes from G-CSF-mobilized peripheral blood stem cell collections carry surface-bound IL-10 and have the potential to modulate alloreactivity

Production of the anti-inflammatory cytokine IL-10 by monocytes has been implicated as a probable negative regulator of graft-versus-host disease (GvHD) in patients undergoing allogeneic stem cell transplants (SCT). Monocytes from G-CSF-mobilized peripheral blood stem cell (gmPBSC) collections have been reported to produce more IL-10 than unmobilized monocytes in response to proinflammatory factors such as LPS. Why this should occur is unclear. In this study, monocyte phenotype and IL-10 localization and release were investigated in PB mononuclear cells (MNC) from 27 healthy donors mobilized for allogeneic SCT and from 13 patients with hematological malignancies mobilized for autologous SCT. All isolates contained elevated total percentages of monocytes in comparison with unmobilized PB, a high proportion of which displayed an immature phenotype. Stimulation of gmPB MNC with an inflammatory stimulus [fixed Staphylococcus aureus cells (SAC)] induced rapid up-regulation of CD14, indicating conversion to mature status. Localization studies indicated that IL-10 was predominantly present, bound on the surface of CD64(+)/CD14(low/neg) immature monocytes. Inflammatory stimuli (LPS, polyinosinic:polycytidylic acid, or SAC) induced release of variable quantities of IL-10 from the cell surface. MNC, separated into surface IL-10-positive or -negative fractions, differed in their ability to stimulate alloreactivity in MLR, and IL-10(+) MNC induced significantly lower levels of proliferation than IL-10(-) MNC. Thus, the subset of immature monocytes carrying surface-bound IL-10 in gmPB has the potential to modulate alloreactivity and GvHD after allogeneic SCT through cell-to-cell contact and released IL-10.

Peripheral blood stem cell mobilization for high-dose chemotherapy

Several studies have clearly documented a more rapid hematopoietic recovery with growth factor-mobilized PBSC than with bone marrow. Time to engraftment for neutrophils and platelets average 8-12 days in contrast to 2-4 weeks after bone marrow. This rapid hematopoietic recovery with PBSC has decreased the duration of hospitalization, transfusion requirements, and costs. Although growth factors alone may mobilize enough PBSC for high-dose chemotherapy, administration of growth factor after submyeloablative chemotherapy increases the yield of CD34+ cells. Based on the current data, CD34+ cell content of PBSC appears to be the single most powerful predictor of hematopoietic recovery. Infusion of > or =5 x 10(6) CD34+ cells/kg is associated with a rapid engraftment of neutrophils and platelets, although successful engraftment has also been reported with infusion of 2.5-5 x 10(6) CD34+ cells/kg. Age, prior radiotherapy, marrow involvement, and prior chemotherapy regimens are important factors influencing the yield of stem cells. Therefore, using these pa-rameters, we may identify the patients who will fail to mobilize sufficient numbers of PBSC before collection and use new strategies for stem cell mobilization. Because of the ease of collection and rapid engraftment after myeloablative therapy, PBSC have replaced bone marrow for autologous transplantation and may supplant bone marrow for allogeneic transplantation in the near future.

Mobilization and harvesting of peripheral blood stem cells: randomized evaluations of different doses of filgrastim

The effects of different doses of filgrastim on yields of CD34+ peripheral blood stem cells were evaluated in patients with breast cancer. 55 were randomized to receive filgrastim 10, 20, 30 or 40 microg/kg/d with more CD34+ cells/kg/apheresis harvested after the three highest dose levels. 35 additional patients were randomized to receive 10 or 30 microg/ kg. The median number of CD34+ cells collected after 10 microg/ kg (n = 31) was 0.7 x 10(6)/kg/apheresis (range 0.1-4.4) as compared to 1.2 (range 0.1-6.8) after 30 microg/kg (n = 32) (P = 0.04). Among patients randomized to 10 v 30 microg/kg, more (50%) achieved > or = 5.0 x 10(6) CD34+ cells/kg and less aphereses were required to achieve > or = 2.5 x 10(6) CD34+ cells/kg after the higher dose (P = 0.04). In multivariate analyses, patients receiving 10 microg/kg (n = 31) had lower yields of CD34+ cells (P = 0.026) and had a 3.3-fold increase in the probability of not achieving > or = 5.0 x 10(6) CD34+ cells/kg as compared to patients receiving 20-40 microg/kg (n = 59). Patients who had received radiation had a 2.9-fold probability of not achieving > or = 2.5 x 10(6) CD34+ cells/kg. These data suggest that, in patients with good marrow reserves, doses of filgrastim > 10 microg/kg/d mobilized more CD34+ cells and may be useful when high numbers of CD34+ cells are desired.

Blood cell transplantation: concepts and concerns

OBJECTIVES

To provide a review of the concepts and concerns for each phase of blood cell transplantation (BCT).

DATA SOURCES

Review articles, research studies, abstracts, and book chapters related to BCT.

CONCLUSIONS

The evaluation of BCT as a major treatment option for a growing number of diseases will challenge nursing professionals. BCT is a complex process that requires conceptual knowledge as well as technical skills.

IMPLICATIONS FOR NURSING PRACTICE

Comprehending specific concepts related to patient eligibility, mobilization, apheresis, cryopreservation, dose-intensive therapy, reinfusion, and marrow engraftment is essential to providing quality nursing care to patients undergoing BCT.

Allogeneic peripheral blood progenitor cells: current status and future directions

Increasing use is being made of mobilized peripheral blood as a source of hematopoietic stem and progenitor cells for transplantation. Initially, these efforts were focused on autologous applications. However, many centers are now using cells derived from normal donors mobilized with recombinant hematopoietic growth factors for allogeneic transplantation. This article reviews the key issues associated with the use of these cells for hematologic reconstitution and summarizes important recent developments in the field.