HIGH-DOSE MELPHALAN FOLLOWED BY AUTOGRAFT EMPLOYING NONCRYOPRESERVED PERIPHERAL-BLOOD PROGENITOR CELLS IN CHILDREN

High-dose chemotherapy followed by autologous bone marrow transplantat ion (ABMT) enables dose escalation in the treatment of childhood malig nancies. Here we report our experience of using peripheral blood proge nitor cells (PBPC) to restore haematopoiesis in five children using a simple cell mobilising regime and non-cryopreservation of the harvests . Cells were mobilised using cyclophosphamide and granulocyte colony s timulating factor. Each patient underwent only two leukaphereses, the product being stored before use at 4 degrees C. Successful autologous PBPC transplantation was achieved with melphalan conditioning chemothe rapy and re-infusion of the total progenitor cell product. No colony s timulating factors were administered after transplantation, The median numbers of mononuclear cells collected per patient was 10.0 x 10(8)/k g (range 8.13-19.44) and CFU-GM 57.6 x 10(4)/kg (range 10.4-178.85). A ll patients subsequently engrafted with the median number of days to a neutrophil count >0.5 x 10(9)/1 being 11 (range 10-16), and to a plat elet count >50 x 10(9)/1 being 14 (range 12-31). The median number of in-patient days was only 20 (range 19-30). The median demand for blood was 2 units (range 1-2), and platelets 4 units (range 2-28). Usage of systemic antimicrobials and intravenous feeding was also low. Using t his simple strategy, collection and transplantation of autologous prog enitor cells can be a straightforward procedure in children. It is pos sible that this could enable dose escalation in some poor prognosis pa ediatric tumours. Copyright (C) 1996 Elsevier Science Ltd