Comparison of subcutaneous and intravenous administration of recombinant human granulocyte-macrophage colony-stimulating factor for peripheral blood stem cell mobilization

The effect of peptide stimulation on haematopoietic stem cell mobilisation including engraftment characteristics and a note on donor side effects

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.

The contribution of animal models to the development of treatments for hematologic recovery following myeloablative therapy: a review

This review describes the role that animal models have played in the development of clinical procedures for growth factor and hematopoietic cell therapies following high-dose cancer chemotherapy, radiotherapy or both. Data are discussed describing animal models that add to the understanding of human hematopoiesis, including myeloid and lymphoid lineage localization and in vivo maturation. Finally, current animal models of cytokine and cell therapies are presented in the context of their contributions to early clinical trials and future therapies. These studies underscore the past and current contributions animal investigations have made to improving clinical therapies.

The Nebraska experience

Autologous peripheral stem cell transplantation was initiated at the University of Nebraska Medical Center to provide hematopoietic rescue for patients who were candidates for high-dose therapy but had marrows that were unfit for autografting. From 1984 until 1991, the cells were collected during steady state without mobilization. These cells restored hematopoietic function at a rate similar to that of autologous marrow in patients not treated with total body irradiation. Patients who received total body irradiation experienced slower hematopoietic recovery. When growth factors became generally available in the United States in 1991, mobilization with cytokines became standard at Nebraska. In recent years, the function of cells other than hematopoietic progenitors contained in a peripheral stem cell apheresis product has been studied. Detection of tumor cells using cell culture, immunocytochemical and polymerase chain reaction techniques has revealed that such collections are less likely to contain, or contain fewer, tumor cells than autologous bone marrow harvests. More antitumor cytotoxic activity was found in cells in peripheral stem cell collections than in marrow cell collections. The immunocompetent lymphocyte population is larger in peripheral stem cell collection than in marrow harvests, and immunologic recovery after peripheral stem cell transplant has differed compared to recovery following bone marrow transplantation. The future of peripheral stem cell transplantation is likely to include engineering of the graft products specific for the patient and disease being treated. Determining the function of accessory cells in a peripheral stem cell collection will be important to provide the best engineered product for the patient.