Cancer Poster Session
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Introduction
PBPC have been used with increasing frequency for autografting following high dose chemotherapy fig. 1. Succesful transplantation of PBPC with complete and sustained engraftment has been shoen in leukemias, lymphomas and solid tumors. When compared with autologous bone marrow transplantation, the advantage of this modality include a more rapid restoration of neutrophils and platelates, the possibilty of autografting when bone marrow aspiration is hampered following radiotherapy of pelvic region. Possibility of reduced contamination with malignant cells is matter of debate.
Materials and Methods
Between January 1995 and June 1998 we performed 301 separation of PBPC in 94 patients. 58 of them was transplanted. Patient characteristics see table 1. All patients Transplantated patients Boys 57 (60,6 %) 35 (60,3 %) Age 12,4 (4- 22) 13,1 (4-22) Ewing´s sa./PNET 25 17 Leukemia 14 14 NHL 14 9 Hodgkin´s disease 12 10 Neuroblastoma 11 8 Soft tissue sarcoma 9 6 Others 9 8 Mobilization schedule: 1/G-CSF 5- 15 mg/kg/ day initiated 48 h after last day of chemotherapy administration or without previous chemotherapy. 2/ G-CSF 10mg/kg/ day initiated 48 h after last day of chemotherapy administration 48 h after last day of chemotherapy administration and GM-CSF 5mg/kg/ day initiated fifth day. CD34+ cells monitoring (flow cytometry, antibody HPCA2, erythrocytes lysed) was initiated in day 3- mobilization without chemotherapy or day 6- mobilization after chemotherapy. Leukapheresis was initiated when CD34+ cells recovers to more than 10x 106/ l. Transplantation of PBPC was performed 2 days after finishing of chemotherapy (26x regimen CCG 3891, 10x Bucy-VP, 9x CBV, 4x St.Jude, 3x Carbopec, 2x POG, 2x CYC-VP a 1x HD alkeran+VCR)
Results
Leukapheresis collection data: MNC 6,65x 108/ kg; CD34+cells 6,67x106/kg; CFU-GM 11,6x 104/kg. Sufficient graft(³3x 106 CD34+ cells, ³ 3x 104 CFU-GM) in 78 patients (83 %). We found significant correlation between number of CD34+ cells and CFU-GM (p < 0,01, Spearman´s correlation coeficient). We did not find significant difference of efficiency of mobilization between mobilization schedules or doses of G-CSF (5- 15 mg/kg/ day). Our findings confirm that lower number of prior chemotherapy regimens is important factor influencing large numbers of CD34+ cells in collections (Demirer T. and Bensinger W.I., 1995. The yield of CD34+ cells in Hodgkin´s disease is significantly higher and in leukemias and generalized NHL is significantly lower ( p< 0,01 resp. p< 0,05, t-test) fig.3. This may be caused either by bone marrow infiltration or by more intensive chemotherapy in leukemias. Our data confirm that recovery of marrow functions after transplantation of PBPC was more rapid than the recovery that follows bone marrow transplantation and patients after PBPC transplantation needs less supportive care (Mangan K.F. , 1995). We found significant negative correlation between number of CD34+ cells and CFU-GM in graft and duration of neutropenia (< 0,5x109/l) (Spearman´s correlation coeficient p<0,001 respectively p<0,005) and number of days with antibiotics (Spearmans correlation coeficient p<0,005 respectively p<0,005).
Discussion and Conclusion
· Our findings confirm, that in majority of children treated for cancer, is possible collect sufficient harvest of PBPC. · We observe a rapid and complete haematopoietic recovery in children receiving PBPC autograft.
References
Demirer T., and Bensinger W.I.: Optimization of peripheral blood stem cell collection. Curr.Opin.Hematol., 1995, 2:219 Mangan K.F.: Peripheral blood stem cell transplantation: From laboratory to clinical practice. Sem.Oncology, 1995,22:202
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