ALLOGENEIC TRANSPLANTS OF RHG-CSF-MOBILIZED PERIPHERAL-BLOOD STEM-CELLS (PBSC) FROM NORMAL DONORS

There is a growing interest in the use of peripheral blood stem cells (PBSC) for allogeneic transplantation. This is due in part to the idea that, as with autologous transplantation, increasing the number of al logeneic hemopoietic progenitors infused may lead to reduced complicat ions. However, introducing the PBSC technique into allogeneic transpla nts implies theoretical as well as ethical problems involving both pat ient and donor. We are still uncertain whether the PBSC technique will result in an increase of GVHD or (better) of GVL. G-CSF, necessary fo r effective PBSC mobilization, is safe but its use in normal subjects should be regarded with caution. For this reason, a Study Committee pr omoted by the GITMO (Gruppo Italiano Trapianto di Midollo Osseo) evalu ated the key aspects of allogeneic PBSC collection and transplantation . The present paper summarizes the scientific data and suggests some g uidelines for the introduction of allogeneic PBSC transplantation into clinical practice. The procedure should be considered experimental an d the Committee strongly recommends the use of allogeneic PBSC in expe rienced centers, initially in patients with advanced disease. The dono r should be given a complete explanation of the advantages and risks o f G-CSF therapy, leukapheresis and general anesthesia. A careful monit oring of both patient and donor should also be included to watch for s hort-term and long-term side effects.