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Granulocyte colony‐stimulating factor mobilized whole blood containing over 0·3 × 10 6 /kg CD34 + cells is a sufficient graft in autologous transplantation for relapsed non‐Hodgkin's lymphoma
Author(s) -
Jonkhoff Andries R.,
De Kreuk Arne M.,
Franschman Gaby,
Van Der Lelie Johannes,
Schuurhuis Gerrit J.,
Dräger Angelika M.,
Zweegman Sonja,
Huijgens Peter C.,
Ossenkoppele Gert J.
Publication year - 2002
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.2002.03636.x
Subject(s) - carmustine , etoposide , melphalan , medicine , cytarabine , granulocyte colony stimulating factor , transplantation , lymphoma , gastroenterology , surgery , chemotherapy
Summary. The feasibility of unprocessed, granulocyte colony‐stimulating factor (G‐CSF)‐mobilized whole blood (WB) as an alternative stem cell source for autologous stem cell transplantation was studied. Forty‐seven relapsed non‐Hodgkin's lymphoma (NHL) patients entered the study. After two or three ifosfamide, methotrexate and etoposide (IMVP) courses, 1 l of G‐CSF‐mobilized WB was collected and stored refrigerated for 72 h. Meanwhile, BAM conditioning was given: BCNU (carmustine) 300 mg/m 2 , high‐dose cytarabine 6000 mg/m 2 and melphalan 140 mg/m 2 . Toxicity, haematological recovery and survival were assessed and compared with peripheral blood stem cell transplantation (PBSCT) and bone marrow transplantation (BMT) reference groups. High‐dose G‐CSF (2 × 12 µg/kg/d) gave the best mobilization results. Haematological recovery was related to the WB CD34 + content. A CD34 + threshold of ≥ 0·3 10 6 /kg, obtained in 90% of patients using high‐dose G‐CSF, correlated with adequate recovery: absolute neutrophil count (ANC) > 0·5 × 10 9 /l: median 12 d (range 9–19). Platelet recovery > 20 and > 50 × 10 9 /l was 19 (11–59) and 30 d (14 not reached) respectively. Overall survival of patients < 60 years was 57% at 4 years and event‐free survival was 32%. Survival was comparable with PBSCT and BMT after BEAM (BCNU, etoposide, cytarabine, melphalan). Remarkably, haematological recovery after BAM + WB was rapid and comparable (ANC) or slightly prolonged (platelets) in comparison with BEAM + PBSCT, despite a 10–20 times lower CD34 + cell dose in the WB graft. In conclusion, transplantation of WB containing ≥ 0·3 × 10 6 /kg CD34 + cells after BAM conditioning is a safe procedure, and offers a fully equivalent and less costly alternative for PBSC.