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Determine safety of outpatient chemotherapy and autotransplants using refrigerated, non‐frozen grafts in persons with multiple sclerosis
Author(s) -
Gale Robert Peter,
GómezCruz Gisela Berenice,
OlivaresGazca Juan Carlos,
LeónPeña Andrés A.,
GómezAlmaguer David,
GómezDeLeón Andrés,
GonzálezLópez Elías Eugenio,
RuizArgüelles Alejandro,
SotoVega Elena,
MuñozPérez María José,
RuizDelgado Guillermo José,
RuizArgüelles Guillermo José
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13567
Subject(s) - medicine , filgrastim , surgery , chemotherapy , hematopoietic cell , cyclophosphamide , hematopoietic stem cell transplantation , transplantation , granulocyte colony stimulating factor , haematopoiesis , stem cell , biology , genetics
Background Persons with multiple sclerosis are increasingly treated with intermediate‐ or high‐dose chemotherapy and a hematopoietic cell autotransplant. This is often done in an inpatient setting using frozen blood cell grafts. Objective Determine if chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using refrigerated, non‐frozen grafts. Methods We developed an autotransplant protocol actionable in an outpatient setting using a refrigerated, non‐frozen blood graft collected after giving cyclophosphamide, 50 mg/kg/d × 2 days and filgrastim, 10 μg/kg/d. A second identical course was given 9 days later followed by infusion of blood cells stored at 4°C for 1‐4 days. The co‐primary outcomes were rates of granulocyte and platelet recovery and therapy‐related mortality. Results We treated 426 consecutive subjects. Median age was 47 years (range, 21‐68 years). A total of 145 (34%) were male. Median graft refrigeration time was 1 day (range, 1‐4 days). Median interval to granulocytes >0.5 × 10E + 9/L was 8 days (range, 2‐12) and to platelets >20 × 10E + 9/L, 8 days (range, 1‐12). Only 15 subjects (4%) were hospitalized, predominately for iatrogenic pneumothorax (N = 5) and neutropenic fever (N = 4). There was only 1 early death from infection. Conclusion Intermediate‐dose chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using, refrigerated, non‐frozen grafts.