S. Murea et al., SUCCESSFUL COLLECTION AND TRANSPLANTATION OF PERIPHERAL-BLOOD STEM-CELLS IN CANCER-PATIENTS USING LARGE-VOLUME LEUKAPHERESES, Journal of clinical apheresis, 11(4), 1996, pp. 185-194
It was the aim of our study to determine the collection efficiency and
yield of CD34+ cells in 88 cancer patients (pts, 44 males/44 females)
who underwent 154 large-volume leukaphereses (LV-LPs). The diagnoses
were as follows: 18 patients had Non-Hodgkin's lymphoma, 9 Hodgkin's d
isease, 24 multiple myeloma, 6 acute leukemia, 27 breast cancer, and 4
patients had solid tumors of different types. During the course of LV
-LPs, 20 liters (l) of blood were processed at a median flow-rate of 8
5 ml/min (CS 3000 Baxter) and 130 ml/min (COBB Spectra), respectively.
Peripheral blood stem cells (PBSC) were collected following granulocy
te colony-stimulating factor (G-CSF)supported cytotoxic chemotherapy.
A 31% and 21% mean decrease in the platelet and white blood count was
noted at the end of the LV-LPs when compared with the pre-leukapheresi
s values. The aphereses were well tolerated without adverse effects. T
he level of circulating CD34+ cells was closely related to the number
of CD34+ cells contained in the respective leukapheresis product (R =
0.89, P < 0.001). Compared with 270 patients who underwent 838 regular
10 l LPs, the yield of CD34+ cells/kg was almost two-fold greater (4.
84 +/- 0.63 X 10(6) [Mean +/- SEM] vs. 2.60 +/- 0.16 X 10(6), P < 0.00
1). The antigenic profile of CD34+ cells was assessed in 54 separate p
roducts collected on the occasion of 27 LV-LPs following the processin
g of 10 l and 20 l, respectively. The intra-individual comparison incl
uded differentiation- as well as lineage-associated markers (CD38, Thy
-1, c-kit, CD33, CD45RA). No difference in the subset composition was
observed between the first and second product, arguing against a prefe
rential release of particular CD34+ cell subsets during the procedure.
As shown by molecular biological or immunocytochemical examination, t
he likelihood of harvesting malignant cells using large-volume apheres
es was not increased in comparison with regular leukaphereses. Single
harvests of greater than or equal to 2.5 X 10(6) CD34+ cells/kg could
be obtained in 74% of the patients, compared with 52% in case of regul
ar LPs. As the majority of patients were autografted with more than 2.
5 X 10(6) CD34+ cells/kg following high-dose therapy, hematological re
covery in general was rapid and not related to the type of apheresis p
roduct used. Considering patient comfort and savings in resource utili
zation, large-volume leukaphereses have become the standard procedure
for PBSC collection in our center. (C) 1996 Wiley-Liss, Inc.