Administration of erythopoietin and granulocyte colony-stimulating factor in donor/recipient pairs to collect peripheral blood progenitor cells (PBPC) and red blood cell units for use in the recipient after allogeneic PBPC transplantation

Background and Objectives. It may be useful to reduce the exposure of trans plant recipients to homologous blood. This may be achieved by procuring don or-derived red blood cell (RBC) units, collecting more peripheral blood pro genitor cells (PBPC) with a combination of granulocyte colony-stimulating f actor (G-CSF) + recombinant human erythropoietin (rHuEpo) and by administer ing rHuEpo post-transplantation. Design and Methods. Eight ABO-compatible donors were treated with rHuEpo an d intravenous iron to collect 12 RBC units for use in their recipients. PBP C were collected after mobilization with rHuEpo and G-CSF in the same donor s. The recipients received G-CSF and rHuEpo post-transplantation. A control group of 10 donor/recipient pairs received G-CSF alone for PBPC mobilizati on and after the transplantation. Results. Eighty-six out of 91 planned RBC units were collected in the donor s without significant decrease in hematocrit because of a 4-fold increase i n RBC production despite functional iron deficiency. After 2 leukaphereses, the cumulative yields of NC and CFU-GM were lower in the study group while those of BFU-E, CFU-Mix and CD34+ cells were similar. However, erythroid r ecovery was significantly accelerated in the study group. Interpretation and Conclusions. Collection of 12 RBC units within 6 weeks i s feasible with rHuEpo and intravenous iron; this strategy allows a dramati c reduction in recipient exposure to homologous blood; rHuEpo has no synerg istic effect with G-CSF for mobilization of PBPC in normal donors and may e ven be deleterious; and rHuEpo in the recipient may enhance erythroid engra ftment. (C) 2001, Ferrata Storti Foundation.