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Peripheral blood stem cell transplantation: Impact on procedure load and workload in an apheresis unit
Author(s) -
Ghalie Richard,
McLeod Bruce,
Richman Carol,
Valentino Leonard,
Manson Sharon,
Netols Carol,
Kaizer Herbert
Publication year - 1992
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.2920070408
Subject(s) - medicine , apheresis , cyclophosphamide , bone marrow , granulocyte colony stimulating factor , etoposide , leukapheresis , surgery , transplantation , chemotherapy , stem cell , urology , gastroenterology , platelet , cd34 , biology , genetics
Peripheral blood stem cells (PBSC) reinfusion appears to hasten hematologic reconstitution following myeloablative therapy. While procurement of PBSC adds apheresis procedures, rapid engraftment could decrease the demand for platelet transfusions. To determine the impact of PBSC collection on workload in our apheresis unit, we studied 3 consecutive groups of patients with metastatic breast cancer given comparable high‐dose chemotherapy and autologous bone marrow transplant, with or without PBSC or granulocyte‐colony stimulating factor (G‐CSF). Forty‐one transplants were performed with bone marrow cells only: 31 patients (Group A) did not receive G‐CSF, while the following 10 patients (group B) received daily G‐CSF until neutrophil engraftment. Bone marrow cells and PBSC were used for the most recent 11 transplants (group C), followed by daily G‐CSF until engraftment. PBSC were mobilized with cyclophosphamide (4 g/m 2 ) and etoposide (1 g/m 2 ), followed by G‐CSF, 8 μg/kg/day. PBSC collection was carried out on a Fenwal CS3000 + cell collector, using modified procedure 1, to obtain a minimum of 5 × 10 8 mononuclear cells/kg. The times to neutrophil count over 500/μL, platelet count over 20,000/μL, and discharge from the hospital after transplant were significantly shorter for patients in group C (medians of 8, 8, and 21 days, respectively) compared to group A (medians of 14, 14, and 29 days; P = 0.001) or group B (medians of 11, 24, and 32 days; P < 0.001). The number of single‐donor platelet equivalents transfused (1 SDE = 1 unit of single‐donor platelets or 8 pooled random‐donor platelets) was significantly decreased in group C (median = 4) compared to group A (median = 19) and group B (median = 11; P = 0.001 for both comparisons). The total apheresis procedure load (the sum of SDE and PBSC collection for each transplant) was significantly decreased in group C (median = 6) compared to groups A and B combined (median = 14; P = 0.001). The apheresis unit workload assessing apheresis durations per patient, calculated as 2 × SDE + 4 × PBSC, was also significantly reduced in group C (median = 16) compared to groups A and B (median = 28; P = 0.002). Thus, PBSC were advantageous in terms of faster engraftment, reduced platelet transfusions, and shorter hospitalization, while decreasing both procedure load and net workload per patient in the apheresis unit. © 1992 Wiley‐Liss, Inc.