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Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem-cell mobilization

Watts, MJ; Sullivan, AM; Leverett, D; Peniket, AJ; Perry, AR; Williams, CD; Devereux, S; ... Linch, DC; + view all (1998) Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem-cell mobilization. J CLIN ONCOL , 16 (4) 1554 - 1560.

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Abstract

Purpose: To assess hematologic recovery and procedure-related mortality in patients who received high-dose therapy with stem-cell support, in whom the peripheral-blood stem-cell (PBSC) collection fails (CD34+ cells < 1 x 10(6)/kg). The predictive value of granulocyte-monocyte colony-forming cell (GM-CFC) measurements and the value of bone marrow obtained after PBSC collection failure was assessed,Patients and Methods: The study group comprised 324 consecutive patients mobilized with granulocyte colony-stimulating factor (G-CSF) and cyclophosphamide (273 patients), G-CSF with other chemotherapy (37 patients), and G-CSF alone (14 patients), Between one and four aphereses were performed,Results: In 51 of 324 patients, there was failure to obtain 1 x 10(6)/kg CD34+ cells, Twenty-three patients had greater than 1 x 10(5)/kg GM-CFC; 22 patients proceeded to high-dose therapy, Neutrophil recovery occurred within 21 days, but platelet independence was delayed (> 28 days) in eight patients, Of 28 patients with less than 1 x 10(5)/kg GM-CFC, six received high-dose therapy with PBSC alone and five had delayed engraftment, Twelve patients with less than 1 x 10(5)/kg GM-CFC received high-dose therapy supported by bone marrow collected after PBSC collection failure, Eleven patients were assessable for engraftment; four patients had slow (> 21 days) or delayed (> 28 days) neutrophil recovery and eight patients had delayed platelet recovery, In the group of patients who received less than 1 x 10(5)/kg GM-CFC, there were five procedure-related deaths,Conclusion: This study shows that delayed hematologic recovery is frequent if less than 1 x 10(6)/kg CD34+ cells are infused after high-dose therapy, particularly with GM-CFC less than 1 x 10(5)/kg, The procedure-related mortality in this latter group is high, In most patients whose PBSC collection contains less than 1 x 10(5)/kg GM-CFC, the use of bone marrow cells does not improve engraftment, which suggests that poor PBSC mobilization usually indicates poor marrow function. (C) 1998 by American Society of Clinical Oncology.

Type: Article
Title: Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem-cell mobilization
Keywords: COLONY-STIMULATING FACTOR, HIGH-DOSE CHEMOTHERAPY, PROGENITOR-CELL, RANDOMIZED TRIAL, HEMATOPOIETIC RESCUE, TRANSPLANTATION, ENGRAFTMENT, LYMPHOMA, COLLECTIONS, RECOVERY
URI: http://discovery.ucl.ac.uk/id/eprint/33573
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