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Meriç N, Parmaksız A, Gülbaş Z. Determination of the relationship between CD34+ stem cell amount and DMSO in hematopoetic stem cell transplantation. Transpl Immunol 2023; 78:101831. [PMID: 37019290 DOI: 10.1016/j.trim.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
It is important to calculate the CD34+ stem cell (SC) count at the right time in patients with hematological malignancies who will undergo Hematopoietic Stem Cell Transplantation (HSCT). The amount of SC infused into the patient affects the engraftment time and healing process of the patient. In this study, we aimed to compare which of the DMSO-not removed and DMSO-removed samples showed the CD34 + SC amount more accurately as the SC amount determination method after the SC was dissolved after cryopreservation in patients who will undergo HSCT. A total of 22 patients were included in the study. All 22 patients were transplanted from frozen samples using DMSO. After the SC products were dissolved in a 37 °C water bath, they were washed 2 times and the amount of CD34+ SC was studied from the samples taken by removing DMSO and without removing DMSO. In the findings, the amounts of CD34+ SC studied with both methods were compared. The increase in the number and percentage of CD34+ SC after DMSO-removed was found to be statistically significant both in terms of difference and proportionally, and the calculated effect sizes also showed that the increase was clinically significant (Cohen's d is between 0.43 and 0.677). After thawing the frozen SCs of the patients who will undergo HSCT, the analysis of CD34+ SCs from which DMSO is removed provides a more accurate calculation of the CD34+ SC amount in the AP.
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2
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Kumkhaek C, Uchida N, Tisdale JF, Rodgers GP. Comparison of CD34 + cells isolated from frozen cord blood and fresh adult peripheral blood of sickle cell disease patients in gene correction of the sickle mutation at late-stage erythroid differentiation. Br J Haematol 2021; 194:e80-e84. [PMID: 34060073 DOI: 10.1111/bjh.17564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Chutima Kumkhaek
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI)/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health, Bethesda (NIH), Bethesda, MD, USA
| | - Naoya Uchida
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI)/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health, Bethesda (NIH), Bethesda, MD, USA.,Division of Molecular and Medical Genetics, Center for Gene and Cell Therapy, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - John F Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI)/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health, Bethesda (NIH), Bethesda, MD, USA
| | - Griffin P Rodgers
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI)/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health, Bethesda (NIH), Bethesda, MD, USA
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3
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Rohner N, Passweg JR, Tsakiris DA, Halter JP, Heim D, Buser AS, Infanti L, Holbro A. The value of the post-thaw CD34+ count with and without DMSO removal in the setting of autologous stem cell transplantation. Transfusion 2018; 59:1052-1060. [PMID: 30556582 DOI: 10.1111/trf.15107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND CD34+ cell count correlates with engraftment potency after autologous stem cell transplantation. Assessment of CD34+ mainly occurs after apheresis and before cryopreservation with dimethyl sulfoxide (DMSO). The influence of postthaw CD34+ cell numbers over time to engraftment is not well studied, and determination of postthaw CD34+ cell counts is challenging for a variety of reasons. The aim of this retrospective study was to systematically assess the value of postthaw CD34+ cell counts in autologous grafts with and without DMSO removal. STUDY DESIGN AND METHODS Between January 2008 and December 2015, 236 adult patients underwent a total of 292 autologous stem cell transplantations. Median age at transplantation was 56 years, and the main indication was multiple myeloma (60%). DMSO removal was done in 96 grafts (33%), either by centrifugation or by Sepax method. RESULTS Patients receiving grafts containing DMSO showed a significantly faster platelet (p = 0.02) and RBC (p = 0.001) engraftment. DMSO removal was not associated with fewer infusion-related adverse events. We observed a good correlation between CD34+ cell count after apheresis and CD34+ cell count after thawing/washing (r = 0.931). Ninety grafts (31%) showed a significant loss of viable CD34+ cells, which translated into a delayed engraftment. CONCLUSION DMSO removal was associated with delayed platelet and RBC engraftment without preventing adverse events. CD34+ cell enumeration after thawing remains difficult to perform, but grafts showing higher cell loss during cryopreservation and thawing are associated with slower engraftment. Prospective studies on the role of DMSO removal and postthaw CD34+ enumeration using defined protocols are needed.
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Affiliation(s)
- Nicolai Rohner
- Division of Hematology, University Hospital Basel, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Switzerland
| | | | - Jörg P Halter
- Division of Hematology, University Hospital Basel, Switzerland
| | - Dominik Heim
- Division of Hematology, University Hospital Basel, Switzerland
| | - Andreas S Buser
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Laura Infanti
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
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4
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Bai L, Best G, Xia W, Peters L, Wong K, Ward C, Greenwood M. Expression of Intracellular Reactive Oxygen Species in Hematopoietic Stem Cells Correlates with Time to Neutrophil and Platelet Engraftment in Patients Undergoing Autologous Bone Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1997-2002. [PMID: 29933068 DOI: 10.1016/j.bbmt.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
Reactive oxygen species (ROS) play important roles in hematopoiesis and regulate the self-renewal, migration, and myeloid differentiation of hematopoietic stem cells (HSCs). This study was conducted to determine whether ROS levels in donor HSCs correlate with neutrophil and platelet engraftment in patients after bone marrow transplantation. Cryopreserved HSC samples from 51 patients who underwent autologous transplantation were studied. Levels of intracellular ROS were assessed by flow cytometry using 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) in the CD45+/CD34+ HSC population. Colony forming unit assays were performed on HSCs isolated from the ROShigh and ROSlow populations to assess the differentiation potential of these 2 cell subsets. Distinct populations of ROShigh and ROSlow cells were evident in all patient samples. The median percentage of ROShigh expressing HSCs in the study cohort was 75.8% (range, 2% to 95.2%). A significant correlation was identified between the percentage of ROShigh stem cells present in the hematopoietic progenitor cells collected by apheresis product infused and the time to neutrophil engraftment (P < .001, r = -.54), as well as time to plt20, plt50, and plt100 (P < 0.001; r = -.55, -.59, and -.56 respectively). The dose of CD34+/ROShigh/kg infused also inversely correlated with a shorter time to neutrophil engraftment; time to engraftment for patients receiving > or ≤3 × 106 cells/kg was 11.5 days (range, 9 to 23) versus 14 days (range, 10 to 28), respectively (P = .02). The dose of ROShigh HSCs delivered did not correlate with platelet engraftment. Collectively, these data suggest that the dose of ROShigh stem cells delivered to patients may predict time to neutrophil engraftment after autologous transplantation.
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Affiliation(s)
- Lijun Bai
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, New South Wales, Australia.
| | - Giles Best
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, New South Wales, Australia
| | - Wei Xia
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, New South Wales, Australia
| | - Lyndsay Peters
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kelly Wong
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Ward
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia; Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, New South Wales, Australia
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5
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Heini AD, Berger MD, Seipel K, Taleghani BM, Baerlocher GM, Leibundgut K, Banz Y, Novak U, Pabst T. Consolidation with autologous stem cell transplantation in first remission is safe and effective in AML patients above 65 years. Leuk Res 2016; 53:28-34. [PMID: 27978458 DOI: 10.1016/j.leukres.2016.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
The outcome of AML patients ≥65 years remains disappointing. Current post-induction strategies for elderly AML patients fit for intensive treatment involve additional cycles of chemotherapy or allogeneic transplantation. Consolidation with autologous transplantation (ASCT) is poorly studied in these patients. In this single-center retrospective analysis, we determined survival rates of AML patients ≥65 years undergoing busulfan/cyclophosphamide conditioning before ASCT in first remission between 2007 and 2015. We found elderly AML patients with ASCT to have longer progression-free survival (PFS; 16.3 vs. 5.1 months, P=0.0166) and overall survival (OS; n.r. vs. 8.2 months; P=0.0255) than elderly AML patients without ASCT consolidation. In addition, elderly AML patients undergoing ASCT had comparable PFS (P=0.9462) and OS (P=0.7867) as AML patients below 65 years receiving ASCT consolidation in CR1. Our data suggest that ASCT is an option in elderly fit AML patients who appear to benefit from autologous consolidation similarly to younger AML patients.
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Affiliation(s)
- Alexander D Heini
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Katja Seipel
- Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | | | - Gabriela M Baerlocher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Kurt Leibundgut
- Department of Pediatric Hemato-Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Yara Banz
- Institute of Pathology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Switzerland.
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6
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Chen Y, Huang XJ, Wang Y, Liu KY, Chen H, Chen YH, Zhang XH, Wang FR, Han W, Wang JZ, Yan CH, Zhang YY, Sun YQ, Xu LP. Febrile reaction associated with the infusion of haploidentical peripheral blood stem cells: incidence, clinical features, and risk factors. Transfusion 2015; 55:2023-31. [PMID: 26099052 DOI: 10.1111/trf.13167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND We reported febrile reaction after the infusion of haploidentical peripheral blood stem cells (PBSCs). The aim of this study was to better characterize this new clinical entity named by infusion-related febrile reaction (IRFR). STUDY DESIGN AND METHODS A retrospective analysis of 490 patients received allogeneic stem cell transplantation (SCT) between October 2009 and December 2011 at our institution. RESULTS The distribution of transplant type was 173 patients in HLA-identical siblings, 30 in unrelated, and 287 in haploidentical. IRFR was defined as unexplained fever of more than 38°C within 24 hours after the infusion of allogeneic PBSCs. We did not observe any IRFRs in patients undergoing HLA-identical sibling and unrelated transfusions. After excluding patients with a known source of infection, we classified haploidentical patients into IRFR and non-IRFR groups. Eighty-eight patients (30.7%) of 287 cases after the infusion of haploidentical PBSCs were diagnosed as IRFRs, chills in 3.5% (10/88), diarrhea in 21.6% (19/88), an erythematous skin rash in 0.3% (1/88), hypoxemia in 1.0% (3/88), and no other accompanying symptoms in 62.5% (55/88). Significantly higher elevation of C-reactive protein and complement C3 was seen in the IRFR group compared with the non-IRFR group. Multivariate analysis showed higher CD34+ dose was a significant predictor for IRFR (p = 0.023; hazard ratio = 1.848; 95% confidence interval, 1.087-3.142). CONCLUSION As a clinical feature belonging to haploidentical SCT, IRFR was associated with the higher numbers of CD34+ from PBSCs.
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Affiliation(s)
- Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China
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7
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Flommersfeld S, Sohlbach K, Jaques G, Bein G, Hoffmann J, Kostrewa P, Sachs UJ. Collection of peripheral blood progenitor cells on Day 4 is feasible and effective while reducing granulocyte-colony-stimulating factor exposure to healthy donors. Transfusion 2015; 55:1269-74. [DOI: 10.1111/trf.13002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/18/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kristina Sohlbach
- Department of Hematology, Oncology, and Immunology; University Hospital Giessen and Marburg, Marburg Campus; Marburg Germany
| | - Gabriele Jaques
- Department of Hematology, Oncology, and Immunology; University Hospital Giessen and Marburg, Marburg Campus; Marburg Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University; Giessen Germany
| | - Jörg Hoffmann
- Department of Hematology, Oncology, and Immunology; University Hospital Giessen and Marburg, Marburg Campus; Marburg Germany
| | - Philippe Kostrewa
- Department of Hematology, Oncology, and Immunology; University Hospital Giessen and Marburg, Marburg Campus; Marburg Germany
| | - Ulrich J. Sachs
- Center for Transfusion Medicine and Hemotherapy
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University; Giessen Germany
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8
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Fulawka L, Donizy P, Halon A. Cancer stem cells--the current status of an old concept: literature review and clinical approaches. Biol Res 2014; 47:66. [PMID: 25723910 PMCID: PMC4335556 DOI: 10.1186/0717-6287-47-66] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/13/2014] [Indexed: 12/14/2022] Open
Abstract
As regards their morphology and biology, tumours consist of heterogeneous cell populations. The cancer stem cell (CSC) hypothesis assumes that a tumour is hierarchically organized and not all of the cells are equally capable of generating descendants, similarly to normal tissue. The only cells being able to self-renew and produce a heterogeneous tumour cell population are cancer stem cells. CSCs probably derive from normal stem cells, although progenitor cells may be taken into consideration as the source of cancer stem cells. CSCs reside in the niche defined as the microenvironment formed by stromal cells, vasculature and extracellular matrix. The CSC assays include FACS sorting, xenotransplantation to immunodeficient mice (SCID), incubation with Hoechst 33342 dye, cell culture in non-adherent conditions, cell culture with bromodeoxyuridine. CSCs have certain properties that make them resistant to anticancer therapy, which suggests they may be the target for potential therapeutic strategies.
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Affiliation(s)
- Lukasz Fulawka
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, ul. Borowska 213, Wroclaw, 50-556, Poland. .,Department of Pathomorphology, Lower Silesian Oncology Centre, pl. Hirszfelda 12, Wroclaw, 53-413, Poland.
| | - Piotr Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, ul. Borowska 213, Wroclaw, 50-556, Poland.
| | - Agnieszka Halon
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, ul. Borowska 213, Wroclaw, 50-556, Poland.
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9
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Bai L, Xia W, Wong K, Reid C, Ward C, Greenwood M. Factors predicting haematopoietic recovery in patients undergoing autologous transplantation: 11-year experience from a single centre. Ann Hematol 2014; 93:1655-64. [DOI: 10.1007/s00277-014-2112-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 05/11/2014] [Indexed: 11/30/2022]
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10
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Bai L, Xia W, Wong K, Reid C, Ward C, Greenwood M. Infused neutrophil dose and haematopoietic recovery in patients undergoing autologous transplantation. Bone Marrow Transplant 2014; 49:725. [PMID: 24566713 DOI: 10.1038/bmt.2014.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L Bai
- 1] Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia [2] Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, NSW, Australia
| | - W Xia
- 1] Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia [2] Cellular Therapeutic Laboratory, Northern Blood Research Centre, Kolling Research Institute, Sydney, NSW, Australia
| | - K Wong
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - C Reid
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - C Ward
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - M Greenwood
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
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11
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Gawronski K, Rzepecki P, Oborska S, Wasko-Grabowska A. Hematologic recovery in patients who are treated with autologous stem cells transplantation taken from bone marrow after granulocyte-colony-stimulating factor stimulation. Transplant Proc 2012; 43:3114-5. [PMID: 21996240 DOI: 10.1016/j.transproceed.2011.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We sought to compare hematologic recovery between patients who did or did not receive granulocyte-colony-stimulating factor (G-CSF)-stimulated bone marrow (rich bone marrow [RBM]). MATERIALS AND METHODS The study subjects were 20 patients whose bone marrow was taken without prior stimulation with G-CSF and 15 patients in whom bone marrow was taken after previous G-CSF mobilization. The bone marrow harvest took place on the fifth day after G-CSF initiation. The bone marrow aliquot was 20 mL/kg. RESULTS The median value of nucleated cells obtained from patients without G-CSF preparation was 3.65×10(8)/kg. The median value of nucleated cells from RBM patients was 4.83×10(8)/kg. The median value of stem cells obtained from patients without G-CSF preparation was 0.96×10(6)/kg versus 1.9×10(6)/kg from RBM patients. The median time to recovery of the hematopoietic system based on an increase in PLT value>20 g/L was 12.6 days for RBM versus 18.8 days without G-CSF preparation. The median time to recovery of the hematopoietic system based on assessment of growth ANC>0.5 g/L was 13.0 days for RBM versus 17.8 days without G-CSF stimulation. Significantly higher values of nucleated cells and increased stem cells were observed among RBM patients compared with those whose bone marrow was harvested without any stimulation (P=.01). There was faster recovery of the hematopoietic system in cases where bone marrow was collected after G-CSF: PLT>20 g/L (P=.015) and ANC>0.5 g/L (P=.01). We also observed that the use of stimulated bone marrow shortened hospital stay after the administration of hematopoietic cells to 17.3 days compared with 23.1 days among patients receiving hematopoietic cells from nonstimulated bone marrow. The number of complications during transplantation was comparable in both cases, the most frequent ones being febrile neutropenia and grade III and IV mucositis. CONCLUSION RBM is a better method to obtain stem cells from bone marrow. Stimulated bone marrow shows faster engraftment compared with nonstimulated bone marrow helping patients who fail to generate are adequate number of stem cells from peripheral blood.
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Affiliation(s)
- K Gawronski
- Bone Marrow Transplantation Unit, Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
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12
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Bachier C, Potter J, Potter G, Sugay R, Shaughnessy P, Chan K, Jude V, Madden R, LeMaistre CF. High white blood cell concentration in the peripheral blood stem cell product can induce seizures during infusion of autologous peripheral blood stem cells. Biol Blood Marrow Transplant 2011; 18:1055-60. [PMID: 22178402 DOI: 10.1016/j.bbmt.2011.12.500] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/02/2011] [Indexed: 01/11/2023]
Abstract
Seizures as a complication of the infusion of autologous peripheral blood stem cells (PBSC) are rare. Seizures during infusion of autologous PBSC in 3 of our patients prompted us to review our cell therapy and cytapheresis protocols and procedures. We retrospectively analyzed 159 adult patients collected between January 2006 and July 2009. Patients were collected on either the COBE Spectra (Caridian BCT, Lakewood, CO) cell separator (n = 85) or Fresenius AS (Fresenius Kabi AG, Bad Homburg, Germany) 104 cell separator (n = 74) and mobilized with granulocyte-colony stimulating factor (G-CSF) alone (n = 47), G-CSF and Plerixafor (n = 36), or G-CSF and chemotherapy (n = 76). Patient characteristics (including age, weight, number of collections, volume processed, disease type, and mobilization strategy) did not differ significantly between the COBE and Fresenius cohorts, and adverse effects from infusion were similar except for 3 of 159 patients who experienced seizures upon infusion of PBSC; all 3 were collected on the COBE and had PBSC product white blood cell (WBC) counts of 590 × 10(3)/μL or above. We prospectively correlated WBC counts midcollection, with final WBC counts to identify products with high WBC concentration during cytapheresis. Fifty-one patients had 66 cytapheresis procedures using the COBE, with WBC counts midway and at the end of collection of 287 × 10(3) ± 150/μL and 273 × 10(3) ± 144/μL, respectively. Mid-WBC therefore correlated with WBC at the end of the collection. Finally, we prospectively collected mid-WBC from 65 patients who underwent 80 PBSC collections between June 2009 and January 2010 to identify products with midcollection WBC concentration >450 × 10(3)/μL. In those cases, additional autologous plasma was collected at the time of collection to dilute the final product before cryopreservation. Patients who received diluted products experienced no delays in engraftment and no additional seizure episodes occurred.
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Affiliation(s)
- Carlos Bachier
- Texas Transplant Institute, 7711 Louis Pasteur, San Antonio, TX, USA.
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13
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Alencar S, Garnica M, Luiz RR, Nogueira CM, Borojevic R, Maiolino A, Dutra HS. Cryopreservation of peripheral blood stem cell: the influence of cell concentration on cellular and hematopoietic recovery. Transfusion 2010; 50:2402-12. [DOI: 10.1111/j.1537-2995.2010.02743.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Clarke DM, Yadock DJ, Nicoud IB, Mathew AJ, Heimfeld S. Improved post-thaw recovery of peripheral blood stem/progenitor cells using a novel intracellular-like cryopreservation solution. Cytotherapy 2009; 11:472-9. [PMID: 19499402 DOI: 10.1080/14653240902887242] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AIMS Peripheral blood stem cells (PBSC) have become the preferred stem cell source for autologous hematopoietic transplantation. A critical aspect of this treatment modality is cryopreservation of the stem cell products, which permits temporal separation of the PBSC mobilization/collection phase from the subsequent high-dose therapy. While controlled rate-freezing and liquid nitrogen storage have become 'routine' practice in many cell-processing facilities, there is clearly room for improvement as current cryopreservation media formulations still result in significant loss and damage to the stem/progenitor cell populations essential for engraftment, and can also expose the patients to relatively undefined serum components and larger volumes of dimethylsulfoxide (DMSO) that can contribute to the morbidity and mortality of the transplant therapy. METHODS This study compared cryopreservation of PBSC in a novel intracellular-like, fully defined, serum- and protein-free preservation solution, CryoStor (BioLife Solutions Inc.), with a standard formulation used by the Fred Hutchinson Cancer Research Center (FHCRC). Briefly, human PBSC apheresis specimens were collected and 5 x 10(7) cells/1 mL sample vial were prepared for cryopreservation in the following solutions: (a) FHCRC standard, Normosol-R, 5% human serum albumin (HAS) and 10% DMSO; and (b) CryoStor CS10 (final diluted concentration of 5% DMSO). A standard controlled-rate freezing program was employed, and frozen vials were stored in the vapor phase of a liquid nitrogen freezer for a minimum of 1 week. Vials were then thawed and evaluated for total nucleated cell count (TNC), viability, CD34 and granulocytes by flow cytometry, along with colony-forming activity in methylcellulose. RESULTS The PBSC samples frozen in CryoStor CS10 yielded significantly improved post-thaw recoveries for total viable CD34(+), colony-forming units (CFU) and granulocytes. Specifically, relative to the FHCRC standard formulation, cryopreservation with CS10 resulted in an average 1.8-fold increased recovery of viable CD34(+) cells (P=0.005), a 1.5-fold increase in CFU-granulocyte-macrophage (GM) numbers (P=0.030) and a 2.3-fold increase in granulocyte recovery (P=0.045). CONCLUSIONS This study indicates that use of CryoStor for cryopreservation can yield significantly improved recovery and in vitro functionality of stem/progenitor cells in PBSC products. In addition, it is important to note that these improved recoveries were obtained while not introducing any extra serum or serum-derived proteins, and reducing the final concentration/volume of DMSO by half. Further in vitro and in vivo studies are clearly necessary; however, these findings imply use of CryoStor for cryopreservation could result in improved engraftment for those patients with a lower content of CD34(+) cells in their PBSC collections, along with reducing the requirement for additional apheresis collections and decreasing the risk of adverse infusion reactions associated with higher exposure to DMSO.
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15
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Dugan MJ, Maziarz RT, Bensinger WI, Nademanee A, Liesveld J, Badel K, Dehner C, Gibney C, Bridger G, Calandra G. Safety and preliminary efficacy of plerixafor (Mozobil) in combination with chemotherapy and G-CSF: an open-label, multicenter, exploratory trial in patients with multiple myeloma and non-Hodgkin's lymphoma undergoing stem cell mobilization. Bone Marrow Transplant 2009; 45:39-47. [PMID: 19483760 DOI: 10.1038/bmt.2009.119] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Plerixafor, a novel CXCR4 inhibitor, is effective in mobilizing PBSCs particularly when used in conjunction with G-CSF. In four cohorts, this pilot study explored the safety of plerixafor mobilization when incorporated into a conventional stem cell mobilization regimen of chemotherapy and G-CSF. Forty (26 multiple myeloma and 14 non-Hodgkin's lymphoma) patients were treated with plerixafor. Plerixafor was well tolerated and its addition to a chemo-mobilization regimen resulted in an increase in the peripheral blood CD34+ cells. The mean rate of increase in the peripheral blood CD34+ cells was 2.8 cells/microl/h pre- and 13.3 cells/microl/h post-plerixafor administration. Engraftment parameters were acceptable after myeloblative chemotherapy, with the median day for neutrophil and plt engraftment being day 11 (range 8-20 days) and day 13 (range 7-77 days), respectively. The data obtained from the analysis of the cohorts suggest that plerixafor can safely be added to chemotherapy-based mobilization regimens and may accelerate the rate of increase in CD34+ cells on the second day of apheresis. Further studies are warranted to evaluate the effect of plerixafor in combination with chemomobilization on stem cell mobilization and collection on the first and subsequent days of apheresis, and its impact on resource utilization.
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Affiliation(s)
- M J Dugan
- Indiana Blood & Marrow Transplantation, Indianapolis, IN 46107, USA.
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16
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Vaughan W, Seshadri T, Bridges M, Keating A. The principles and overview of autologous hematopoietic stem cell transplantation. Cancer Treat Res 2009; 144:23-45. [PMID: 19779877 DOI: 10.1007/978-0-387-78580-6_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- William Vaughan
- University of Alabama Bone Marrow Transplantation Program, University of Alabama Comprehensive Cancer Center, Birmingham, AL, USA.
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17
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Seshadri T, Al-Farsi K, Stakiw J, Ma C, Saragosa R, Franke N, Keating A, Crump M, Kuruvilla J. G-CSF-stimulated BM progenitor cells supplement suboptimal peripheral blood hematopoietic progenitor cell collections for auto transplantation. Bone Marrow Transplant 2008; 42:733-7. [DOI: 10.1038/bmt.2008.249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Zhang C, Chen X, Zhang X, Gao L, Kong P, Wang Q, Peng X, Liu H. Mobilization of peripheral blood stem cells for autologous transplantation patients with hematological malignancies: Influence of disease, mobilization method, age and sex. Transfus Apher Sci 2008; 39:21-8. [PMID: 18599353 DOI: 10.1016/j.transci.2008.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Autologous peripheral blood stem cells transplantation (Auto-PBSCT) is a therapeutic option which can be used in various hematological neoplastic disorders; and it can prolong disease-free survival and total survival. Many factors could influence the mobilization of peripheral blood stem cells for patients of Auto-PBSCT. In this study, we investigated the variables influencing the mobilization of peripheral blood stem cells in 240 patients with hematological malignancies who had undergone Auto-PBSCT between 2001 and March 2007 in our center, retrospectively. Patients with acute myelogenous leukemia had the most collected mononuclear cells (MNCs) and patients with acute lymphoblastic leukemia had the most collected CD34(+) cells than did other patients. However, patients with multiple myeloma had the least collected MNCs and CD34(+) cells. Patients mobilized with chemotherapy with granulocyte colony stimulating factor (G-CSF) plus recombinant human interleukin-11(rhIL-11) had the most collected MNCs and CD34(+) cells. The difference is statistical signification between chemotherapy with G-CSF and chemotherapy with G-CSF plus rhIL-11 for collected MNCs (P<0.05). Adults had the most collected MNCs and CD34(+) cells and the difference is statistical signification between children/adolescent and older, children/adolescent and adult for CD34(+) cells (P<0.05). Male patients had the more collected MNCs and CD34(+) cells and the difference is statistical signification for CD34(+) cells (P<0.05). The adverse events were not serious during mobilization. In conclusion, many factors could influence the mobilization of peripheral blood stem cells, and our findings emphasize the need to optimize harvesting technique to enhance safety and minimize morbidity and costs of this valuable procedure.
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Affiliation(s)
- Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University Chongqing, People's Republic of China.
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19
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Donmez A, Cagirgan S, Saydam G, Tombuloglu M. Overnight refrigerator storage of autologous peripheral progenitor stem cells without cryopreservation. Transfus Apher Sci 2007; 36:313-9. [PMID: 17569591 DOI: 10.1016/j.transci.2007.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
We compared cryopreservation of peripheral blood progenitor cell (PBPC) products immediately and after overnight storage. There was no statistically significant difference in the groups regarding median CD(34)+ cell count of the product, storage duration at -80 degrees C, viability rates, neutrophil and platelet engraftment days. Overnight storage of products with leukocyte count >300x10(9)/l has longer leukocyte (P=0.03) and platelet (P=0.01) engraftment days compared to other groups. Overnight storage without adding any medium or plasma for the apheresis product with leukocyte count of less than 300x10(9)/l in a commercially available refrigerator can easily and safely be used in transplantation centers.
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Affiliation(s)
- Ayhan Donmez
- Ege University Medical School, Department of Hematology, 35100 Bornova, Izmir, Turkey.
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20
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Hicks C, Wong R, Manoharan A, Kwan YL. Viable CD34+/CD133+ blood progenitor cell dose as a predictor of haematopoietic engraftment in multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation. Ann Hematol 2007; 86:591-8. [PMID: 17492259 DOI: 10.1007/s00277-007-0297-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 02/20/2007] [Accepted: 04/03/2007] [Indexed: 11/26/2022]
Abstract
Both CD34 (cluster of differentiation 34) and the more recently described CD133 are markers of primitive stem cells with haematopoietic repopulating ability. Most transplanting centres use a minimum number of CD34+ cells as the requirement for a transplant and consider this a predictor of haematopoietic engraftment. However, transplanted CD34+ cell dose does not always give a close correlation with time to engraftment nor explain delayed engraftment in some patients. We have retrospectively evaluated the potential of measuring viable CD133+ cell numbers in the autograft as an alternative predictor of haematological engraftment after autologous stem-cell transplantation in a cohort of patients with multiple myeloma (MM). We found an average 32% loss of viability of CD34+ cells in the post-thaw sample compared with the fresh sample. Of the original estimated CD34+ cell numbers transplanted per kg, 43% of the thawed samples were double positive for CD34+/CD133+. In this patient group, the CD34+/CD133+ subset gave the closest statistical correlation with time to neutrophil engraftment (p < 0.05), particularly for patients given above median (1.8 x 10(6)/kg) dose of the double-positive cells. The CD34+/CD133+ population was the only parameter to give a significant correlation with white cell engraftment in this patient cohort (p < 0.05). There was no significant correlation between CD34+, viable CD34+ or viable CD34+/CD133+ cells/kilogram with platelet engraftment. Determination of viable CD34+/CD133+ progenitor cell dose in the autograft may be a useful tool to predict neutrophil recovery after autologous transplantation than conventional assessment of CD34+ numbers. These results warrant further investigation of the role of CD133 in haematopoietic engraftment.
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Affiliation(s)
- C Hicks
- Department of Clinical Haematology, Bone Marrow Transplant Laboratory, St. George Hospital, Kogarah, 2217 Sydney, NSW, Australia.
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21
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Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod 2007; 33:377-90. [PMID: 17368324 DOI: 10.1016/j.joen.2006.09.013] [Citation(s) in RCA: 507] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 09/10/2006] [Accepted: 09/18/2006] [Indexed: 12/16/2022]
Abstract
Millions of teeth are saved each year by root canal therapy. Although current treatment modalities offer high levels of success for many conditions, an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize teeth. Researchers are working toward this objective. Regenerative endodontics is the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. This review provides an overview of regenerative endodontics and its goals, and describes possible techniques that will allow regenerative endodontics to become a reality. These potential approaches include root-canal revascularization, postnatal (adult) stem cell therapy, pulp implant, scaffold implant, three-dimensional cell printing, injectable scaffolds, and gene therapy. These regenerative endodontic techniques will possibly involve some combination of disinfection or debridement of infected root canal systems with apical enlargement to permit revascularization and use of adult stem cells, scaffolds, and growth factors. Although the challenges of introducing endodontic tissue engineering therapies are substantial, the potential benefits to patients and the profession are equally ground breaking. Patient demand is staggering both in scope and cost, because tissue engineering therapy offers the possibility of restoring natural function instead of surgical placement of an artificial prosthesis. By providing an overview of the methodological issues required to develop potential regenerative endodontic therapies, we hope to present a call for action to develop these therapies for clinical use.
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Affiliation(s)
- Peter E Murray
- Department of Endodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA.
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22
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Donmez A, Tombuloglu M, Gungor A, Soyer N, Saydam G, Cagirgan S. Clinical side effects during peripheral blood progenitor cell infusion. Transfus Apher Sci 2007; 36:95-101. [PMID: 17236813 DOI: 10.1016/j.transci.2006.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 05/16/2006] [Indexed: 10/23/2022]
Abstract
There are several side effects which have been reported during the infusion of peripheral blood progenitor cells (PBPCs) either due to the infusion or the content of the infusate. We have evaluated the side effects detected during PBPCs infusion in 194 autologous and 25 allogeneic transplantations. In autologous cryopreserved PBPCs infusion, we detected a total of forty-nine (25.25%) side effect events during and after the infusion period. Forty-six (23.71%) of these side effects were detected during the infusion period including fifteen (7.73%) cardiac side effects, which required stopping the infusion, and thirty-one (15.97%) non-cardiac side effects, which did not require cessation of the infusion. Sinus bradycardia after a minimum of 45 min after completing the infusion was seen in three (1.54%) patients. The median volume, dimethyl sulfoxide (DMSO) and total nucleated cell (TNC) content of the product were found to be significantly higher in patients with side effects compared to the group without any side effects (P<0.05). The median volume and DMSO content were found to be significantly higher in patients with cardiac side effects compared to non-cardiac side effects (P<0.05). There was no cardiac side effects in patients treated with an infusate containing 100 x 10(9) L(-1) leukocytes. We did not observe any infusion-related side effects in patients given allogeneic non-cryopreserved PBPCs. We have concluded that the volume, DMSO and TNC content of autologous cryopreserved PBPCs product are directly related to clinical side effects.
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Affiliation(s)
- Ayhan Donmez
- Ege University Medical School Hospital, Department of Internal Medicine, Division of Hematology, Bornova, 35100 Izmir, Turkey.
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23
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Sheean PM, Freels SA, Helton WS, Braunschweig CA. Adverse Clinical Consequences of Hyperglycemia from Total Parenteral Nutrition Exposure during Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2006; 12:656-64. [PMID: 16737939 DOI: 10.1016/j.bbmt.2006.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 01/28/2006] [Indexed: 01/08/2023]
Abstract
Immunocompromised hematopoietic stem cell transplant (HSCT) recipients frequently receive total parenteral nutrition (TPN), a dextrose-based solution that may exacerbate the infectious risks associated with hyperglycemia. This study assessed the incidence of hyperglycemia (glucose level>or=110 mg/dL) and its effect on clinical outcomes in TPN versus non-TPN recipients who received HSCTs. A retrospective cohort of 357 adults who were admitted for initial autologous or allogeneic transplantation at 2 university-affiliated centers was examined. To discern the temporality of outcomes, "before" and "after" comparisons were made by using actual infusion times for TPN patients and using timeframes based on mean hospital days before ("before") or during ("after") parenteral infusion for non-TPN patients. Patients demonstrated similar demographic and clinical characteristics when analyzed by institution, feeding, and donor-type strata, and 57% received TPN. After attempts to equilibrate disease acuity were employed, the proportion of hyperglycemic days was equivalent before but significantly greater after in patients exposed versus unexposed to TPN (87.5% versus 8.3%, respectively; P<.001). Using logistic regression, the likelihood of infection doubled (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.4-3.5) after adjustment for donor type, diagnosis, age, gender, ethnicity, institution, mucositis, and obesity. This association was only slightly attenuated when patients with infections before were removed (OR, 1.9; 95%, CI, 1.1-3.3), steroid recipients were eliminated (OR, 2.1; 95% CI, 1.2-3.4), and when patients with nonablative regimens were excluded (OR, 2.1; 95% CI, 1.3-3.5), but was considerably higher for patients who were classified as normal or underweight (body mass index<or=25 kg/m2; n=118; OR, 4.3; 95% CI, 1.7-10.6). In addition, the effect of TPN became insignificant when glucose was added as an independent variable, thus symbolizing their collinear relation. Parenteral nutrition recipients versus nonrecipients also developed significantly greater requirements for red cell (P=.001) and platelet transfusions (P=.001) after and significant delays in granulocyte and platelet engraftment times for autologous (P=.01) and allogeneic (P=.02) subjects. The broad use of TPN in patients undergoing initial HSCT was associated with profound hyperglycemia, resultant greater morbidity, and questionable efficacy in this adult, well-nourished cohort.
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Affiliation(s)
- Patricia M Sheean
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60612, USA
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Donmez A, Zoghi M, Cagirgan S, Acarlar C, Tombuloglu M. The effect of hematopoietic progenitor cells’ temperature on cardiac arrhythmias in patients given peripheral blood progenitor cells. Transfus Apher Sci 2006; 34:245-51. [PMID: 16931400 DOI: 10.1016/j.transci.2005.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 12/06/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Infusion of cryopreserved and non-cryopreserved hematopoietic progenitor cells (HPC) is associated with a broad variety of symptoms. In this study, we have investigated infusion-related toxicity regarding temperature of cryopreserved autologous peripheral blood progenitor cells (PBPCs) transplanted in 31 and allogeneic non-cryopreserved PBPCs in 4 patients receiving high dose chemotherapy and stem cells transplantation for hematological malignancies. STUDY DESIGN AND METHOD A 24h ECG-Holter recording system was used to obtain cardiac arrhythmias. Two milliliters HPC were collected from entrance site of venous access to evaluate the temperature of infused HPC. RESULTS We have detected arrhythmias in 17 (48.58%) of our patients before, during and after infusion. Median temperature of the infusat was 21 degrees C (18-28.2). Arrhythmias during infusion were detected in 8 (22.85%) patients. The temperatures of infused HPCs were not statistically different in group with and without arrhythmias as 22 degrees C and 21 degrees C, respectively (P>0.05). And also, volume, contents [dimethylsulphoxide (DMSO), red blood cells (RBC), platelet (PLT), and total nucleated cell (TNC)] of product, and rate of infusion speed did not have any effect on arrhythmias. CONCLUSION As a result of this study, we have concluded that the temperature of HPC does not cause any systemic hypothermia and does not have any relation to arrhythmias detected during infusion.
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Affiliation(s)
- Ayhan Donmez
- Department of Hematology, Ege University Medical School, Izmir, Turkey.
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25
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Abstract
Bone marrow transplantation for lysosomal storage disorders has been used for the past 25 years. The early allure of a promising new therapy has given way to more realistic expectations, as it has become clear that bone marrow transplantation is not a cure, but merely ameliorates the clinical phenotype. The results in some disorders are more acceptable than in others. Significant challenges have emerged, particularly the poor mesenchymal and neurological responses. Important recent advances in lysosomal biology, both in health and disease, have helped us to better understand the results of bone marrow transplantation, and to rationalize its role in the treatment of lysosomal storage disorders alongside newer therapies. At the same time, they have helped researchers to explore new therapeutic applications of bone marrow cells, such as gene and stem cell therapy.
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Affiliation(s)
- Ashok Vellodi
- a Consultant Paediatrician and Honorary Reader, Great Ormond Street Hospital for Children, Metabolic Unit, NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
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26
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Borberg H. Quo vadis haemapheresis. Current developments in haemapheresis. Transfus Apher Sci 2006; 34:51-73. [PMID: 16412691 DOI: 10.1016/j.transci.2005.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 11/08/2005] [Indexed: 01/13/2023]
Abstract
The techniques of haemapheresis originated in the development of centrifugal devices separating cells from plasma and later on plasma from cells. Subsequently membrane filtration was developed allowing for plasma-cell separation. The unspecificity of therapeutic plasma exchange led to the development of secondary plasma separation technologies being specific, semi-selective or selective such as adsorption, filtration or precipitation. In contrast on-line differential separation of cells is still under development. Whereas erythrocytapheresis, granulocytapheresis, lymphocytapheresis and stem cell apheresis are technically advanced, monocytapheresis may need further improvement. Also, indications such as erythrocytapheresis for the treatment of polycythaemia vera or photopheresis though being clinically effective and of considerable importance for an appropriate disease control are to some extent under debate as being either too costly or without sufficient understanding of the mechanism. Other forms of cell therapy are under development. Rheohaemapheresis as the most advanced technology of extracorporeal haemorheotherapy is a rapidly developing approach contributing to the treatment of microcirculatory diseases and tissue repair. Whereas the control of a considerable number of (auto-) antibody mediated diseases is beyond discussion, the indication of apheresis therapy for immune complex mediated diseases is quite often still under debate. Detoxification for artificial liver support advanced considerably during the last years, whereas conclusions on the efficacy of septicaemia treatment are debatable indeed. LDL-apheresis initiated in 1981 as immune apheresis is well established since 24 years, other semi-selective or unspecific procedures, allowing for the elimination of LDL-cholesterol among other plasma components are also being used. Correspondingly Lp(a) apheresis is available as a specific, highly efficient elimination procedure superior to techniques which also eliminate Lp(a). Quality control systems, more economical technologies as for instance by increasing automation, influencing the over-interpretation of evidence based medicine especially in patients with rare diseases without treatment alternative, more insight into the need of controlled clinical trials or alternatively improved diagnostic procedures are among others tools ways to expand the application of haemapheresis so far applied in cardiology, dermatology, haematology, immunology, nephrology, neurology, ophthalmology, otology, paediatrics, rheumatology, surgery and transfusion medicine.
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Affiliation(s)
- Helmut Borberg
- German Haemapheresis Centre, Deutsches Haemapherese Zentrum, Maarweg 165, D-50 825 Köln, Germany.
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Archundia A, Aceves JL, López-Hernández M, Alvarado M, Rodriguez E, Díaz Quiroz G, Páez A, Rojas FM, Montaño LF. Direct cardiac injection of G-CSF mobilized bone-marrow stem-cells improves ventricular function in old myocardial infarction. Life Sci 2005; 78:279-83. [PMID: 16183081 DOI: 10.1016/j.lfs.2005.04.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 04/21/2005] [Indexed: 11/26/2022]
Abstract
Autologous transplant of bone marrow stem cells (BMSC), although extremely useful after acute myocardial events, has not been evaluated in patients with old (>one-year-old) myocardial infarction. Our aim was to determine if CD34(+)-enriched peripheral-blood cells, obtained by apheresis, injected directly into the severely damaged myocardium of five patients with old myocardial infarction could restore depressed myocardial function. We found that 28 weeks after revascularization and peri-infarction injection of the enriched CD34(+) peripheral mononuclear cells, ventricular hemodynamic parameters that included left ventricular ejection fraction, left ventricular diastolic volume, ventricular systolic volume and left ventricular diastolic diameter approximated normal values and there was no restenosis; two patients have been followed for >52 weeks and their parameters are within normal values. In conclusion, intramyocardial injection of easily obtained CD34(+) enriched peripheral blood cells represent an encouraging procedure for patients with severely scarred and dysfunctional myocardium.
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Affiliation(s)
- Abel Archundia
- Departamento de Cirugía Cardiovascular, CMN 20 de Noviembre, ISSSTE, México DF, México
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28
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Ahn JS, Park S, Im SA, Yoon SS, Lee JS, Kim BK, Bang SM, Cho EK, Lee JH, Jung CW, Kim HC, Seong CM, Lee MH, Kim CS, Lee KS, Lee JA, Ahn MJ. High-dose versus low-dose cyclophosphamide in combination with G-CSF for peripheral blood progenitor cell mobilization. Korean J Intern Med 2005; 20:224-31. [PMID: 16295781 PMCID: PMC3891157 DOI: 10.3904/kjim.2005.20.3.224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To compare the mobilizing effects and toxicities of two different doses of cyclophosphamide (CY) plus lenograstim (glycosylated G-CSF), we performed a prospective randomized study by enrolling patients suffering with either high-risk Non-Hodgkin's lymphoma (NHL) or breast cancer undergoing ablative chemotherapy. METHODS The NHL patients received 4 cycles of CHOP and the breast cancer patients received 2-3 cycles of FAC (FEC) adjuvant chemotherapy. Then, the patients were randomly allocated to receive CY 4 g/m2 (arm A) or 1.5 g/m2 (arm B) in combination with lenograstim. Large volume leukapheresis was carried out and it was continued daily until the target cell dose of 2 x 10(6) CD34+ cell/kg was reached. RESULTS Twenty-seven patients were enrolled in the study. The median number of leukaphereis sessions actually performed was 2.5 sessions in arm A and 3 sessions in arm B. The target cell dose was obtained with the median number of one leukapheresis session in both arms of the study (p=0.09). The collected number of CD34+ cells in the leukapheresis products was higher in arm A than arm B (22.4 vs. 9.9 x 10(6)/kg, respectively, p=0.05). Grade III or IV leukopenia was present in 14/15 patients (94%) in arm A and in 1/12 patients (8%) in arm B (p<0.0001). Grade Ill or IV thrombocytopenia was present in 8/15 patients (54%) in arm A, but this was not present in any patients of arm B (p=0.0004). Neutropenic fever occurred in 6/15 patients (40%) in arm A, and in 1/12 patients (8%) in arm B (p=0.09). The hematological recovery of the leukocytes and platelets after transplantation was not statistically different between the two doses. CONCLUSION Low-dose CY plus lenograstim is a safe and effective mobilizing regimen.
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Affiliation(s)
- Jin Seok Ahn
- Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Seonyang Park
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Byoung Kook Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Eun Kyung Cho
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Chul Won Jung
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hugh Chul Kim
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Chu Myung Seong
- Department of Internal Medicine, College of Medine, Ewha Womans University, Seoul, Korea
| | - Moon Hee Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Chul Soo Kim
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Keun Seok Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Jung Ae Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Myung-Ju Ahn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Riley RS, Idowu M, Chesney A, Zhao S, McCarty J, Lamb LS, Ben-Ezra JM. Hematologic aspects of myeloablative therapy and bone marrow transplantation. J Clin Lab Anal 2005; 19:47-79. [PMID: 15756708 PMCID: PMC6807857 DOI: 10.1002/jcla.20055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The transplantation of bone marrow cells or isolated hematopoietic stem cells from the bone marrow or peripheral blood is a widely utilized form of therapy for patients with incurable diseases of the hematopoietic and immune systems. Successful engraftment of the transplanted stem cells in an adequately prepared recipient normally leads to bone marrow reconstitution over a period of several weeks, accompanied by more gradual reconstitution of the immune system. Since the recipient is profoundly ill during the initial treatment period, laboratory data is critical for monitoring engraftment, detecting residual/recurrent disease, and identifying problems that may delay bone marrow reconstitution or lead to other medical complications. Accurate blood cell counts are imperative, and most bone marrow transplantation patients undergo periodic monitoring with bone marrow aspirates and biopsies with cytogenetic, molecular, and multiparametric flow cytometric studies. The potential complications of bone marrow transplantation include engraftment failure and delayed engraftment, infection, residual bone marrow disease, acute and chronic graft versus host disease, myelofibrosis, therapy-related acute leukemia, post-transplant lympho-proliferative disorders, and toxic myelopathy.
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Affiliation(s)
- Roger S Riley
- Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia 23298-0250, USA.
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30
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Leibundgut K, Schmitz NMR, Hirt A. Catalytic Activities of G1Cyclin-Dependent Kinases and Phosphorylation of Retinoblastoma Protein in Mobilized Peripheral Blood CD34+Hematopoietic Progenitor Cells. Stem Cells 2005; 23:1002-11. [PMID: 15941859 DOI: 10.1634/stemcells.2004-0088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depending on the source of cells, the cell cycle status of hematopoietic stem and progenitor cells capable of repopulating the marrow of transplant recipients is controversial. In this study, using biochemical methods, the cell cycle status of mobilized CD34+ cells was analyzed. It was demonstrated in CD34+ cell extracts that there was high catalytic activity of G(1) cyclin-dependent kinases 4 and 6 (CDK4 and CDK6) but low activity of CDK2. This was in contrast to the resting reference cells that showed only minimal or no activity of these CDKs. Since at the G0-->G1-->S transition CDK4/6 and CDK2 sequentially phosphorylate the retinoblastoma protein (pRB), its phosphorylation status was analyzed. Previously, we showed that p110RB was unphosphorylated at serine (Ser)-608 in CD34+ cells, consistent with the ability to suppress cell growth. Here, it was established that this form of pRB was phosphorylated at Ser-780, Ser-795, and Ser-807/811 in CD34+ but not in resting reference cells. This result was therefore consistent with the presence of high CDK4/6 activities in CD34+ cells. Conversely, CDK2 activity was low and the pRB residues Ser-612 and threonine (Thr)-821, which are exclusively phosphorylated by CDK2 in conjunction with either cyclin E or A, were unphosphorylated in >90% of CD34+ cells. We therefore show for the first time the exact position of mobilized CD34+ cells within the cell cycle; that is, they do not reside in G0 but in early G1 phase and did not cross the restriction point into late G1 phase.
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Affiliation(s)
- Kurt Leibundgut
- Department of Pediatrics, University of Bern Inselspital, CH-3010, Bern, Switzerland.
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31
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Sartor M, Antonenas V, Garvin F, Webb M, Bradstock KF. Recovery of viable CD34+ cells from cryopreserved hemopoietic progenitor cell products. Bone Marrow Transplant 2005; 36:199-204. [PMID: 15937512 DOI: 10.1038/sj.bmt.1705009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The number of CD34+ cells infused into patients at the time of autologous or allogeneic transplantation is a clinically important variable, but the viability of these cells has not been extensively documented. In this study, we analyzed the recovery of viable CD34+ cells before and after cryopreservation on 79 autologous stem cell products, using a novel flow cytometry assay without red cell lysis. For 70 PBSC harvest samples, the mean viable CD34+ cell count was 5.98 x 10(6)/kg (range 0.3-23 x 10(6)/kg) before freezing and 5.4 x 10(6)/kg (range 0.2-23 x 10(6)/kg) after thawing. The median recovery was 93% (range 48-107%), with 90% recovery for NHL (range 48-100%, n=34), 83% for multiple myeloma (range 56-106%, n=11), 92.3% for acute leukemia (range 71-100% n=7) and 94.5% for nonhematological malignancies (range 50-107% n=18). Similarly, for autologous bone marrows (n=9) the median recovery of viable CD34+ cells was 90% (range 68-100%). The recovery of viable CD34+ cells for adult (n=51) and pediatric (n=28) stem cell collections was 91 and 94%, respectively. Further examination of the correlation between the kinetics of hematological recovery and the number of viable progenitor cells infused, particularly at the lower end of the accepted dose range, may be warranted.
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Affiliation(s)
- M Sartor
- Flow Cytometry Unit, Institute of Clincial Pathology and Medical Research, Westmead Hospital, Sydney, Australia.
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32
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Reddy RL. Mobilization and collection of peripheral blood progenitor cells for transplantation. Transfus Apher Sci 2005; 32:63-72. [PMID: 15737875 DOI: 10.1016/j.transci.2004.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 11/28/2022]
Abstract
Bone marrow transplantation gradually expanded as a treatment modality for various malignant and non malignant disease conditions. Since the discoveries of the potential of Peripheral Blood Progenitor Cells (PBPC) in the hematopoietic reconstitution mid 1980s and early 1990s PBPC gradually replaced bone marrow as the preferred source of stem cells. The introduction of hematopoietic cytokines that can mobilize large number of progenitors into circulation accelerated PBPC usage. Technological advancements in the apheresis instrumentation greatly helped in the conversion from marrow to PBPC. PBPC collection is less painful, less expensive and transplant with PBPC results in faster hematological recovery than with marrow. Almost all of the autologous transplants are currently performed with PBPC and a similar trend is seen with the allogeneic transplants. The progenitor cell mobilization regimen for autologous patients can be cytokines alone or cytokines combined with chemotherapy. In the majority of the patients the required minimal cell dose of 2.5-5.0 x 10(6)/kg CD34+ cells can be collected in one or two apheresis collections. A few of autologous transplant patients who mobilize poorly require several collections. Allogeneic donors are generally mobilized with daily subcutaneous injections of G-CSF 10 microg/kg for 5 days. The PBPC are collected in one or two apheresis procedures. The side effects of G-CSF are generally mild to moderate; however rare serious reactions including rupture of the spleen have been reported. The collection of PBPC in pediatric patients poses additional challenges yet an adequate dose of cells can be collected with the available apheresis instrumentation. The apheresis collection procedures are safe with no serious adverse consequences. Future scientific advancements may expand the use of PBPC for other clinical application in addition to the current use for hematological reconstitution.
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Affiliation(s)
- Ramakrishna L Reddy
- American Red Cross Midwest Region Blood Services and Department of Pathology and Microbiology, University of Nebraska Medical Center, 3838 Dewey Avenue, Omaha, NE 68105, USA.
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33
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Barendse G, Tailford R, Wood L, Jacobs P. The effect of peptide stimulation on haematopoietic stem cell mobilisation including engraftment characteristics and a note on donor side effects. Transfus Apher Sci 2005; 32:105-16. [PMID: 15737879 DOI: 10.1016/j.transci.2004.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 11/28/2022]
Abstract
Aplasia or irreversible bone marrow failure and a variety of haematologic malignancies, as well as an increasing number of solid tumours, currently include various forms of marrow or equivalent transplantation in routine management. In both allogeneic and autologous procedures stable recipient immunohaematopoietic reconstitution depends upon infusing the requisite population harvested at a precise time following commencement of a stimulatory peptide. In a first step this prospective study documented the safety of apheresis, defined side effects and enumerated mononuclear, CD34+ and CD3+ cells obtained. In the second stage delivery of the graft, characterised in this way and with the additional measurement of in vitro growth in clonogenic assay, to the suitably conditioned patient was correlated with recovery of neutrophil and platelet numbers appearing in the circulation. In a third and ongoing analysis the influence of passenger T-lymphocytes is being evaluated for impact on infection and a potential anti-tumour effect. The conclusion is that this technology is reliable, has a high degree of patient acceptability without untoward complications, and that local results correspond to international experience thereby providing an important and relevant measure of quality control.
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Affiliation(s)
- Gameda Barendse
- Department of Haematology and Bone Marrow Transplant Unit incorporating the Searll Laboratory for Research in Cellular and Molecular Biology, Constantiaberg Medi-Clinic, Burnham Road, Plumstead 7800, Cape Town, South Africa
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34
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Li W, Wang G, Cui J, Xue L, Cai L. Low-dose radiation (LDR) induces hematopoietic hormesis: LDR-induced mobilization of hematopoietic progenitor cells into peripheral blood circulation. Exp Hematol 2005; 32:1088-96. [PMID: 15539087 DOI: 10.1016/j.exphem.2004.07.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Revised: 07/14/2004] [Accepted: 07/21/2004] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the stimulating effect of low-dose radiation (LDR) on bone marrow hematopoietic progenitor cell (HPC) proliferation and peripheral blood mobilization. METHODS Mice were exposed to 25- to 100-mGy x-rays. Bone marrow and peripheral blood HPCs (BFU-E, CFU-GM, and c-kit+ cells) were measured, and GM-CSF, G-CSF, and IL-3 protein and mRNA expression were detected using ELISA, slot blot hybridization, and Northern blot methods. To functionally evaluate LDR-stimulated and -mobilized HPCs, repopulation of peripheral blood cells in lethally irradiated recipients after transplantation of LDR-treated donor HPCs was examined by WBC counts, animal survival, and colony-forming units in the recipient spleens (CFUs-S). RESULTS 75-mGy x-rays induced a maximal stimulation for bone marrow HPC proliferation (CFU-GM and BFU-E formation) 48 hours postirradiation, along with a significant increase in HPC mobilization into peripheral blood 48 to 72 hours postradiation, as shown by increases in CFU-GM formation and proportion of c-kit+ cells in the peripheral mononuclear cells. 75-mGy x-rays also maximally induced increases in G-CSF and GM-CSF mRNA expression in splenocytes and levels of serum GM-CSF. To define the critical role of these hematopoietic-stimulating factors in HPC peripheral mobilization, direct administration of G-CSF at a dose of 300 microg/kg/day or 150 microg/kg/day was applied and found to significantly stimulate GM-CFU formation and increase c-kit+ cells in the peripheral mononuclear cells. More importantly, 75-mGy x-rays plus 150 microg/kg/day G-CSF (LDR/150-G-CSF) produced a similar effect to that of 300 microg/kg/day G-CSF alone. Furthermore, the capability of LDR-mobilized donor HPCs to repopulate blood cells was confirmed in lethally irradiated recipient mice by counting peripheral WBC and CFUs-S. CONCLUSION These results suggest that LDR induces hematopoietic hormesis, as demonstrated by HPC proliferation and peripheral mobilization, providing a potential approach to clinical application for HPC peripheral mobilization.
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Affiliation(s)
- Wei Li
- Department of Hematology and Oncology, First University Hospital, PR China
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35
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Jansen J, Hanks S, Thompson JM, Dugan MJ, Akard LP. Transplantation of hematopoietic stem cells from the peripheral blood. J Cell Mol Med 2005; 9:37-50. [PMID: 15784163 PMCID: PMC6741412 DOI: 10.1111/j.1582-4934.2005.tb00335.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Hematopoietic stem cells can be collected from the peripheral blood. These hematopoietic stem cells (HSC), or better progenitor cells, are mostly expressed as the percentage of cells than react with CD34 antibodies or that form colonies in semi-solid medium (CFU-GM). Under steady-state conditions the number of HSC is much lower in peripheral blood than in bone marrow. Mobilization with chemotherapy and/or growth factors may lead to a concentration of HSC in the peripheral blood that equals or exceeds the concentration in bone marrow. Transplantation of HSC from the peripheral blood results in faster hematologic recovery than HSC from bone marrow. This decreases the risk of infection and the need for blood-product support. For autologous stem-cell transplantation (SCT), the use of peripheral blood cells has completely replaced the use of bone marrow. For allogeneic SCT, on the other hand, the situation is more complex. Since peripheral blood contains more T-lymphocytes than bone marrow, the use of HSC from the peripheral blood increases the risk of graft-versus-host disease after allogeneic SCT. For patients with goodrisk leukemia, bone marrow is still preferred, but for patients with high-risk disease, peripheral blood SCT has become the therapy of choice.
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Affiliation(s)
- Jan Jansen
- Indiana Blood and Marrow Transplantation, Beech Grove, IN 46107, USA.
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36
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Sheean PM, Braunschweig C, Rich E. The incidence of hyperglycemia in hematopoietic stem cell transplant recipients receiving total parenteral nutrition: a pilot study. ACTA ACUST UNITED AC 2004; 104:1352-60. [PMID: 15354149 DOI: 10.1016/j.jada.2004.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether total parenteral nutrition (TPN)-induced hyperglycemia is associated with adverse clinical outcomes. DESIGN A retrospective cohort investigation comparing the medical records of hematopoietic stem cell transplant patients was conducted to determine clinical differences between those who received TPN and those who did not receive TPN during transplant. SUBJECTS/SETTING Forty-eight adult patients (> or =18 years) undergoing initial autologous or allogeneic hematopoietic stem cell transplant at two urban university-affiliated hospitals were eligible for inclusion. MAIN OUTCOME MEASURES Hyperglycemia (glucose > or =6.1 mmol/L or 110 mg/dL), presence of infection, infection duration, and in-hospital mortality. Statistical analyses performed chi 2, Student t, and Wilcoxon rank-sum tests were used to detect differences among the study participants. RESULTS Patients had similar baseline demographic and clinical characteristics, with 63% receiving TPN during transplant. When standardized for time, TPN recipients at both institutions experienced significantly more hyperglycemia ( P <.05) after TPN initiation. TPN patients also experienced 69% of all infections and 100% of repeat positive cultures. Additionally, significantly greater differences for TPN recipients were found for length of stay and daily charges than those who did not receive TPN. No differences were found for in-hospital mortality. CONCLUSIONS TPN is strongly associated with hyperglycemia, which may be linked to increased infections of longer duration in a profoundly immunocompromised group of patients who frequently receive TPN. The implications of these findings are limited by the small number of subjects; a larger investigation is warranted.
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Affiliation(s)
- Patricia M Sheean
- Department of Human Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL 60612, USA.
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37
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Perillo A, Ferrandina G, Pierelli L, Rutella S, Mancuso S, Scambia G. Cytokines alone for PBPC collection in patients with advanced gynaecological malignancies: G-CSF vs G-CSF plus EPO. Bone Marrow Transplant 2004; 34:743-4. [PMID: 15334047 DOI: 10.1038/sj.bmt.1704584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Mironov V, Visconti RP, Markwald RR. What is regenerative medicine? Emergence of applied stem cell and developmental biology. Expert Opin Biol Ther 2004; 4:773-81. [PMID: 15174961 DOI: 10.1517/14712598.4.6.773] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Regenerative medicine is an emerging, but still poorly defined, field of biomedicine. The ongoing 'regenerative medicine revolution' is based on a series of new exciting breakthrough discoveries in the field of stem cell biology and developmental biology. The main problem of regenerative medicine is not so much stem cell differentiation, isolation and lineage diversity, although these are very important issues, but rather stem cell mobilisation, recruitment and integration into functional tissues. The key issue in enhancing tissue and organ regeneration is how to mobilise circulating stem and progenitor cells and how to provide an appropriate environment ('niche') for their tissue and organo-specific recruitment, 'homing' and complete functional integration. We need to know more about basic tissue biology, tissue regeneration and the cellular and molecular mechanisms of tissue turnover (both cellular and extracellular components) at different periods of human life and in different diseases. Systematic in silico, in vitro and in vivo research is a foundation for further progress in regenerative medicine. Regenerative medicine is a rapidly advancing field that opens new and exciting opportunities for completely revolutionary therapeutic modalities and technologies. Regenerative medicine is, at its essence, an emergence of applied stem cell and developmental biology.
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Affiliation(s)
- V Mironov
- Medical University of South Carolina, Charleston, SC 29425, USA
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39
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Abrahamsen JF, Wentzel-Larsen T, Bruserud O. Autologous transplantation: the viable transplanted CD34+ cell dose measured post-thaw does not predict engraftment kinetics better than the total CD34+ cell dose measured pre-freeze in patients that receive more than 2×106 CD34+ cells/kg. Cytotherapy 2004; 6:356-62. [PMID: 16146888 DOI: 10.1080/14653240410004925] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of the study was to investigate whether the number of viable CD34+ cells in cryopreserved PBPC autografts is a better predictor of engraftment than the total CD34+ cell number determined before freezing. METHODS A total of 119 patients was treated with autotransplantation for various malignant disorders during the period 1996-2002. All patients were reinfused with at least 2x10(6)/kg total CD34 cells analyzed before programmed freezing in 10% DMSO. The total CD34 cell number determined before freezing was compared with the number of viable cells determined after cryopreservation for 51 of these patients. The number of viable cells was determined by a flow cytometric analysis including triple staining with anti-CD34, anti-CD45 and the viability marker 7-actinomycin D (7-AAD). RESULTS Simple linear regression analyses showed that both the total transplanted CD34 cell dose measured before freezing and the viable CD34 cell dose determined after cryopreservation were significantly correlated with neutrophil and platelet engraftment. In a multiple regression model the prediction of engraftment was not improved when the transplanted viable CD34 cell dose was included as a variable in addition to the total CD34 cell dose measured immediately after collection. DISCUSSION Routine estimation of viable CD34 cells after cryopreservation of PBPC autografts is not necessary as long as the total CD34 cell dose is determined before freezing and the patients are reinfused with at least 2x10(6) cells/kg body weight.
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Affiliation(s)
- J F Abrahamsen
- The Blood Bank, Haukeland University Hospital Bergen Norway
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40
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Ohta Y, Hayakawa S, Karasaki-Suzuki M, Sugita K, Komine S, Chishima F, Hatta Y, Horie T, Seo N, Sheikh A, Nemoto N, Yamamoto T. Granulocyte Colony-stimulating Factor Suppresses Autologous Tumor Killing Activity of the Peripheral Blood Lymphocytes in the Patients with Ovarian Carcinoma. Am J Reprod Immunol 2004; 52:81-7. [PMID: 15214947 DOI: 10.1111/j.1600-0897.2004.00191.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Granulocyte colony-stimulating factor (G-CSF) is often administered to patients with chemotherapy-induced leukocytopenia. However, adequate attention has not been paid to its effects on cancer immunology. Reported by us and others, G-CSF often induces immunosuppression and down-regulation of response T helper (Th)2 directed immune reaction both in vivo and in vitro. In this study, we analyzed the effects of G-CSF on interferon (IFN)-gamma production and autologous tumor killing (ATK) activities of peripheral blood mononuclear cells (PBMCs). METHODS OF STUDY In order to evaluate the cytokine-induced activation of peripheral T and natural killer (NK) cells, we analyzed IFN-gamma production by interleukin (IL)-2- and IL-12-stimulated PBMCs, using the ELISPOT assay. Specific killing of autologous tumor cells was evaluated by lactate dehydrogenase (LDH) release assay. RESULTS The PBMC collected from both cancer-bearing patients and healthy subjects showed IL-2- and/or IL-12-induced IFN-gamma production. The frequency of IFN-gamma producing cells was significantly higher in the normal subjects compared with the patients with advanced ovarian carcinoma. The ATK activity was also enhanced in IL-2- and/or IL-12-stimulated PBMCs of patients with ovarian carcinoma. G-CSF almost completely abolished IFN-gamma production and ATK activity of PBMC stimulated with IL-2 and/or IL-12. CONCLUSIONS The G-CSF appears to be a suppressor of antitumor immunity. Routine administration of G-CSF to cancer patients may not be recommended, except for febrile neutropenia.
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Affiliation(s)
- Yoshiaki Ohta
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
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41
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Seggewiss R, Buss EC, Herrmann D, Goldschmidt H, Ho AD, Fruehauf S. Kinetics of peripheral blood stem cell mobilization following G-CSF-supported chemotherapy. Stem Cells 2004; 21:568-74. [PMID: 12968111 DOI: 10.1634/stemcells.21-5-568] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It would be a clinical and economical advantage if the optimal time point of peripheral blood stem cell (PBSC) mobilization following G-CSF-supported chemotherapy (CT) was known in advance. Therefore, we retrospectively analyzed mobilization parameters in 113 adult tumor patients treated in our institution within 1 year. The start of apheresis was guided by CD34(+) cell measurements in the PB and occurred on or after day 11 after start of mobilization CT in 97% of patients. The median peak (p)CD34(+) cell count in PB uniformly occurred on day 14-15 (range: 6-32 days) after the start of CT, irrespective of the diagnosis (multiple myeloma n = 76, other histology n = 37), the type, but not the amount, of premobilization CT or radiotherapy (RT), the mobilization regimen, or the G-CSF dosage administered. Among more heavily pretreated patients (>six cycles of prior CT or RT), a higher proportion mobilized late (pCD34(+) cell count later than day 20 in 12% and 13%, respectively, versus 2%-5% in the other groups). Therefore, we propose to start measuring CD34(+) cells in the PB on day 11 after the start of mobilization therapy. The wide range of optimal mobilization time points argues for an individualized rather than a preset start of apheresis.
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Affiliation(s)
- Ruth Seggewiss
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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42
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Willing AE, Vendrame M, Mallery J, Cassady CJ, Davis CD, Sanchez-Ramos J, Sanberg PR. Mobilized peripheral blood cells administered intravenously produce functional recovery in stroke. Cell Transplant 2004; 12:449-54. [PMID: 12911133 DOI: 10.3727/000000003108746885] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Filgratism (granulocyte colony stimulating factor, G-CSF)-mobilized peripheral blood progenitor cells (PBPCs) have replaced bone marrow (BM) as a preferred source of autologous stem cells, in light of the faster hematologic recovery and lesser supportive care requirement exhibited by PBPC transplants. Other hematopoietic stem cells, like the human umbilical cord blood-derived stem cells (hUCBs), and nonhematopoietic stem cells have been shown to improve motor function in rodent models of injury and degenerative disease. In the present study we transplanted either G-CSF-mobilized PBPCs or hUCBs in rats 24 h after permanent middle cerebral artery occlusion (MCAO), and assessed their behavioral abnormalities in spontaneous activity and spontaneous motor asymmetry. In both transplanted groups of rats we observed a significant reduction of the stroke-induced hyperactivity compared with nontransplanted, stroked animals. In addition, transplantation of G-CSF PBPC and hUCB cells prevented the development of extensive motor asymmetry. Our findings raise the possibility that PBPCs could provide a novel transplantation therapy to treat stroke.
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Affiliation(s)
- Alison E Willing
- Center of Excellence for Aging & Brain Repair, Department of Neurosurgery, University of South Florida College of Medicine, 12901 Bruce B. Downs Blvd, Tampa, FL 33612, USA.
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43
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Nowrousian MR, Waschke S, Bojko P, Welt A, Schuett P, Ebeling P, Flasshove M, Moritz T, Schuette J, Seeber S. Impact of chemotherapy regimen and hematopoietic growth factor on mobilization and collection of peripheral blood stem cells in cancer patients. Ann Oncol 2003; 14 Suppl 1:i29-36. [PMID: 12736228 DOI: 10.1093/annonc/mdg706] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Various chemotherapy regimens, combined with recombinant human granulocyte colony-stimulating factor(rhG-CSF) or recombinant granulocyte-macrophage CSF (rhGM-CSF) are used in cancer patients to mobilize and collect peripheral blood stem cells (PBSC). In this retrospective study, we evaluated and compared the efficacy of such regimens in 262 patients with different types of malignant diseases. The following chemotherapy regimens were applied: ifosfamide-etoposide-cisplatin or bleomycin (n = 96; mainly patients with testicular cancer); ifosfamide-etoposide plus or minus cytosine arabinoside (Ara-C) or vincristine (VCR)(n = 52; mainly patients with lymphoma); cyclophosphamide-anthracycline (n = 53; mainly patients with breast cancer); intermediate to high dose (ID-HD) cyclophosphamide (n = 37; mainly patients with breast or ovarian cancer. or multiple myeloma; and others (n = 24). rhG-CSF or rhGM-CSF, each at an average daily dose of 5 microg/kg body weight, were used in 166 and 96 patients, respectively. The study evaluated and compared the efficacy of these two cytokines. In patients receiving rhG-CSF, CD34+ cells could be collected earlier (median: day 14 versus day 16) and there was a significantly higher white blood cell count (WBC)(median 11,350 versus 5550/microl) and CD34+ cell count (median 88 versus 43/microl) at the start of apheresis, and a significantly higher CD34+ cell yield (median 7.4 x 10(6) versus 4.6 x 10(6)/kg) than in patients who receivedrhGM-CSF. Among the various chemotherapeutic regimens used, each combined with rhG-CSF, ifosfamide-etoposide plus or minus Ara-C or VCR mobilized a significantly higher number of CD34+ cells (median 119/microl) and produced a significantly higher harvest of these cells (median 13 x 10(6)/kg) than cyclophosphamide-anthracycline (median 87/microl and 7 x 10(6)/kg, respectively) or ID-HD cyclophosphamide (median 59/microl and 5 x I 0(6)/kg, respectively). Ifosfamide-etoposide plus or minus Ara-C or VCR was also superior to ifosfamide-etoposide-cisplatin or bleomycin (median 78/microl and 9 x 10(6)/kg, respectively), but at borderline significance. The outcome of PBSC mobilization and collection appeared to be negatively influenced by the number of relapses before the current salvage treatment. These data indicate that mobilization and collection of PBSCstrongly depend on the type of hematopoietic growth factor and chemotherapeutic regimen used. The data further show rhG-CSF is a more effective growth factor than rhGM-CSF and ifosfamide-etoposide-based regimens, particularly ifosfamide-etoposide plus or minus Ara-C or VCR, are highly effective regimens in mobilizing and collecting CD34+ cells.
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Affiliation(s)
- M R Nowrousian
- Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Essen Medical School, Germany.
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Sugita K, Hayakawa S, Karasaki-Suzuki M, Hagiwara H, Chishima F, Aleemuzaman S, Li JA, Nishinarita S, Yamamoto T. Granulocyte colony stimulation factor (G-CSF) suppresses interleukin (IL)-12 and/or IL-2 induced interferon (IFN)-γproduction and cytotoxicity of decidual mononuclear cells. Am J Reprod Immunol 2003; 50:83-9. [PMID: 14506932 DOI: 10.1034/j.1600-0897.2003.00024.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM The placenta is one of the few non-hematopoietic tissues to express granulocyte colony stimulation factor (G-CSF). Placental G-CSF production is considered to be one of the major causes of granulocytosis during pregnancy although its physiological role in pregnancy has not yet been examined. METHOD OF STUDY The effects of G-CSF on interleukin (IL)-2 and/or IL-12 induced interferon (IFN)-gamma production of magnetic cell sorting (MACS) sorted decidual lymphocytes was examined by enzyme-linked immunosorbent spot-forming cell assay (ELISPOT). The effect of G-CSF on cytotoxicity of decidual lymphocytes against the choriocarcinoma cell line JEG-3 was examined by lactate dehydrogenase (LDH) release assay. RESULTS As previously reported by us, IL-2 and/or IL-12 activated decidual mononuclear cells were capable of killing choriocarcinoma cells. We observed that G-CSF abolished IFN-gamma production and cytotoxicity of decidual mononuclear cells and MACS sorted CD56+ cells. CONCLUSIONS In addition to its well-known trophic effects on hematopoiesis, our results suggest about new roles of G-CSF in reproductive immunology.
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MESH Headings
- Adult
- CD3 Complex/analysis
- CD56 Antigen/analysis
- Cell Line, Tumor/cytology
- Cell Line, Tumor/immunology
- Cytotoxicity, Immunologic/drug effects
- Decidua/immunology
- Dose-Response Relationship, Drug
- Drug Interactions
- Female
- Granulocyte Colony-Stimulating Factor/pharmacology
- Humans
- Interferon-gamma/biosynthesis
- Interferon-gamma/immunology
- Interleukin-12/pharmacology
- Interleukin-2/pharmacology
- Killer Cells, Natural/cytology
- Killer Cells, Natural/immunology
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Pregnancy
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Granulocyte Colony-Stimulating Factor/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- Kenji Sugita
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
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45
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Phillips GL. The potential of amifostine in high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Semin Oncol 2002. [DOI: 10.1016/s0093-7754(02)70011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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