ENGRAFTMENT OF PATIENTS WITH LYMPHOID MALIGNANCIES TRANSPLANTED WITH AUTOLOGOUS BONE-MARROW, PERIPHERAL-BLOOD STEM-CELLS OR BOTH

Forty six patients with lymphoid malignancies receiving autologous tra nsplants using three different sources of hematopoietic stem cells wer e compared for engraftment parameters. Thirteen patients (five with mu ltiple myeloma, seven with non-Hodgkin's lymphoma and one with Hodgkin 's lymphoma) received autologous marrow with post-transplant growth fa ctors (group 1). During the same time interval, 14 patients (five with multiple myeloma, six with non-Hodgkin's lymphoma and three with Hodg kin's lymphoma) were transplanted with autologous marrow plus recombin ant granulocyte colony-stimulating factor (rhG-CSF)-mobilized peripher al blood stem cells (PBSC) and post-transplant growth factors (group 2 ). Nineteen patients (seven with multiple myeloma and 12 with non-Hodg kin's lymphoma) received rhG-CSF mobilized PBSC and post-transplant gr owth factors (group 3). All PBSC were collected after G-CSF mobilizati on (16 mu g/kg/day s.c. for 6 days) without prior chemotherapy. After high-dose myeloablative chemotherapy or chemoradiotherapy, the median days to recovery of neutrophils to levels of 0.5 and 1.0 x 10(9)/I wer e 12 vs. 9 vs. 9 days (P = 0.0003 (group 1 vs. group 2) and P = 0.53 ( group 2 vs, group 3)) and 13 vs. 10 vs. 10 days (P = 0.0003 (group 1 v s. group 2) and 0.92 (group 2 vs. group 3)) for groups 1, 2 and 3, res pectively. The median day to platelet transfusion independence was 22 vs. 11 vs. 11 days (P = 0.001 (group 1 vs. group 2) and P = 0.50 (grou p 2 vs. group 3)) for groups 1, 2 and 3, respectively. The median numb er of units of platelets transfused was 119 vs, 39 vs, 40 (P = 0.0236 (group 1 vs. group 2) and P = 0.83 (group 2 vs, group 3)) for groups 1 , 2 and 3, respectively. No secondary graft failures were observed in any patient. These data demonstrate that G-CSF mobilized peripheral bl ood stem cells are effective in reducing the time of neutropenia, plat elet dependency and days on antibiotics in heavily pre-treated patient s with lymphoid malignancies. PBSC alone appears to be superior to mar row alone for engraftment and the addition of marrow appears to be unn ecessary.