PRACTICAL APPLICATIONS FOR PERIPHERAL-BLOOD PROGENITOR CELLS IN THE TREATMENT OF LYMPHOMAS AND SOLID TUMORS

Autologous blood progenitor cell (BPC) support is used in conjunction with high-dose chemotherapy regimens and also permits the use of incre asing dose-intensity schedules of conventional cytotoxic chemotherapy. However, our understanding of the optimal BPC support to be used in t hese different conditions is incomplete. These difficulties result fro m the use of different BPC collection procedures in different centres, to different patient populations and considerable variability between patients. For such treatment to be cost effective, greater knowledge is required about the best way of achieving mobilisation, collection, storage and engraftment of BPC. The use of G-CSF in combination with c hemotherapy can yield sufficient BPC at a single apheresis to achieve haematopoietic reconstitution after high-dose therapy. This was partly achieved by accurate prediction of the optimum timing of cell collect ion, which coincided with the early exponential increase in white bloo d cells (WBC) after the chemotherapy induced nadir. BPC in apheresis p roduct or whole blood from patients primed with chemotherapy and filgr astim (G-CSF) were found to be viable for 48 hours when stored at 4 de grees C. Patients receiving multicyclic ifosfamide, carboplatin and et oposide (ICE) chemotherapy received BPC in apheresis product or whole blood, which had been stored at 4 degrees C, on day 3 of each treatmen t cycle. Such an approach allowed a 200% increase in dose intensity wi thout any increase in toxicity or the need for supportive care. Optima l use of BPC support may increase the effectiveness of chemotherapy fo r the common solid tumours.