LARGE-VOLUME LEUKAPHERESIS FOR COLLECTION OF MONONUCLEAR-CELLS FOR HEMATOPOIETIC RESCUE IN HODGKINS-DISEASE

Background: Peripheral blood mononuclear cells (MNCs) collected by leu kapheresis contain hematopoietic stem and progenitor cells that provid e autologous hematopoietic rescue after high-dose chemotherapy, an app roach that offers a significant benefit to patients with recurrent Hod gkin's disease. However, patients with low MNC counts may require 10 o r more standard leukapheresis procedures for the collection of suffici ent cells for hematopoietic rescue. Study Design and Methods: The effe ctiveness of steady-state large-volume leukapheresis (LVL; 15-35 L blo od processed) was evaluated as a method for collecting MNCs for hemato poietic rescue in seven patients with recurrent Hodgkin's disease. LVL was performed on 2 consecutive days per week to collect 7 x 10(8) MNC s per kg. The circulating MNC counts on the first day of LVL and the t otal numbers of LVL, of MNCs collected, and of liters of blood process ed were determined per patient. After high-dose chemotherapy and MNC t ransfusion, days to granulocyte and platelet engraftment were recorded . Results: On the first day of LVL, patients had median circulating MN Cs of 1536 (range, 504-3950) x 10(6) per L. The median number of LVL p rocedures per patient was four (range, 1.25-6), and the median L per k g of blood processed was 1.57 (range, 0.38-4.03). Simple regression an alysis plotting L per kg against initial MNCs gave a curve with the eq uation y = e((1.42-(6.31 x 10E-4)x)) (correlation coefficient = -0.97, R(2)= 0.95, exponential fit). Without posttransfusion growth-factor s upport, median days to granulocyte engraftment were 19 (range, 12-26) and those to platelet transfusion independence were 34.5 (range, 10-57 ). Conclusion: LVL provides a useful method of collecting MNCs for hem atopoietic rescue in patients with Hodgkin's disease. The patient's ba seline MNC count provides a useful estimate of the volume required for LVL.