Allogenic transplants with peripheral blood progenitor cells: a report of six cases

Allogeneic PBPC transplantation in children

BACKGROUND

While PBPC are being used increasingly as a source of stem cells in allotransplantation, the published experience in pediatric donor-recipient pairs is limited. Our aim was to evaluate the mobilization of PBPC in healthy child donors and the outcome of child recipients undergoing allogeneic PBSC transplant.

METHODS

Eight children with malignancies AML (one), refractory anemia with excess blasts in transformation (RAEBt) (one), ALL (four), NHL (one) and neuroblastoma (one)] were grafted with PBPC from HLA-identical sibling donors (seven patients) or from a 2-antigen mismatched donor (one case). Donors, aged 1-15 years underwent leukapheresis after mobilization with G-CSF (10-15 g/kg/day, 4 days). The extracorporeal line was primed in five cases (four with HSA). Peripheral venous access was used in all except one infant. The harvests were cryopreserved in six cases. GvHD prophylaxis consisted of CsA plus MTX or methylprednisolone.

RESULTS

No adverse effects related to G-CSF administration, nor procedure-related complications were observed. Median number of CD34(+) cells harvested was 5.18 x 10(6)/kg (range, 2.56-6.40), after one (five cases) or two (three cases) leukaphereses. All patients engrafted. The median time to achieve an ANC > 0.5 x 10(9)/L was 11 days (range 9-13) and a platelet count of > 50 x 10(9)/L was 18 days (range 13-45). Six patients did not develop any acute GvHD and three developed chronic GvHD. After a median follow-up of 18 months (14-44 months), six patients are alive and five in complete remission.

DISCUSSION

Allogeneic PBPC transplantation has shown to be a safe and successful procedure for pediatric donor and recipient pairs.

Allogeneic haemopoietic cell transplants in Australia, 1996--a multi-centre retrospective comparison of the use of peripheral blood stem cells with bone marrow

A retrospective comparison was carried out on adult patients receiving HLA-identical allogeneic haemopoietic stem cell transplants from siblings in Australia in 1996, comparing bone marrow with G-CSF-mobilised peripheral blood stem cells. A total of 131 transplant recipients from nine centres were included in this study, of whom 79 received bone marrow, 44 blood stem cells and eight both. All but three of the 131 patients had cyclosporin and methotrexate as graft-versus-host disease prophylaxis. The minimum follow-up time for surviving patients is 27 months. Comparisons were carried out between the BM and PBSC groups. There were no significant differences between groups in age, sex, diagnosis, donor characteristics or pretransplant conditioning. Median time to neutrophil recovery of 0.5 x 10(9)/l was 14 days for PBSC recipients, compared to 19 days for marrow recipients (P < 0.0005). median time to platelet recovery of 20 x 10(9)/l was 17 days for PBSC recipients, compared to 28 days for marrow recipients (P < 0.0005). there were no significantly increased risks of either acute or chronic GVHD in the PBSC recipients. there were no significant differences between the groups in the incidence of major transplant-related complications, disease-free survival or overall survival.