Use of 'rainy day' autologous haemopoietic stem cells: a single-institution experience over 10 years.

BACKGROUND: High-dose chemotherapy and autologous haematopoietic stem cell transplantation is an important therapeutic modality in the treatment of many haematological malignancies. Generally, stem cells are collected close to the time of the transplant, but an alternative is to collect and cryopreserve cells at an early stage of the illness so they are available for later use ('rainy day harvesting'). Although this practice has been commonplace in Australia, there is little evidence to document eventual use of cells collected in this manner. METHODS: We conducted an audit of indications for and eventual transplantation of 'rainy day' harvests performed at our institution over a 10-year period. RESULTS: Although there was some variation across different disease groups, we found that only 14% of cells were transplanted. The median delay to transplantation was 19 months. CONCLUSION: Together with recent advances in stem cell mobilisation techniques, results from this audit suggest that the practice may not be an effective use of limited health resources.

Accuracy, reproducibility and clinical utility of the CoaguChek S portable international normalized ratio monitor in an outpatient anticoagulation clinic.

The accuracy and reproducibility of the CoaguChek S, and its clinical agreement with conventional laboratory international normalized ratio (INR) determination, were evaluated in an outpatient anticoagulation clinic setting. Forty-three patients provided 248 paired INR measurements for analysis. The paired results were highly correlated (r = 0.90). The mean coefficient of variation for the CoaguChek S for a random sample of 21 patients with three repeated tests each, was 4%. Clinical applicability was also measured by discrepant INR values, as defined in the literature by expanded and narrow agreement, and by INR values resulting in a different clinical decision by a blinded haematology registrar. Expanded agreement and narrow agreement between the two INR values occurred 90 and 88% of the time, respectively. The stricter criteria set down by the clinician resulted in 73% of paired results producing the same dosage decision. The CoaguChek S displayed good correlation with laboratory determination of INR and compared relatively well with expanded and narrow clinical agreement criteria.

Association between high interleukin-6 levels and adverse outcome after autologous haemopoietic stem cell transplantation.

We studied interleukin-6 (IL-6) levels on the day of transplantation in 31 patients undergoing autologous haemopoietic stem cell transplantation (SCT) (either peripheral blood stem cell transplantation (PBSCT) or bone marrow transplantation (BMT)) for neoplastic diseases to determine if there was a relationship between IL-6 level and rate of haemopoietic recovery, length of stay in hospital, and survival. There was no apparent delay in post-transplant recovery associated with elevated IL-6 levels. However, increased values of IL-6 tended to be associated with an increased length of stay in hospital (P = 0.083). There was a highly significant adverse association between higher IL-6 levels and survival following transplantation (P = 0.0001). This association remained significant (P = 0.013) in the uniform subgroup of patients with malignant lymphoma with chemosensitive disease who had undergone BMT (that is, excluding patients who had undergone PBSCT) (n = 13). Knowledge of IL-6 levels on the day of transplant has the potential to provide valuable prognostic information in patients undergoing autologous haemopoietic SCT.

The effect of G-CSF on the composition of human bone marrow.

The effects on bone marrow cellularity and morphology of 6 days' treatment with granulocyte colony-stimulating factor (G-CSF) in 35 patients were studied. Examination of trephine biopsies showed a highly significant increase in cellularity (P < 10-13). Assessment of aspirates revealed an increase in the myeloid to erythroid (M : E) ratio (P = 0.00006), the proportion of myeloid cells (P < 10-8), myelocytes (P = 0.00007), metamyelocytes (P = 0.04), band forms (P = 0.0005) and neutrophils (P = 0.02). This study presents a comprehensive analysis of the effects of six days' administration of G-CSF on human bone marrow.

Hemopoietic stem-cell harvesting and transplantation using G-CSF-primed BM: comparison with unprimed BM and G-CSF-primed PBSC.

BACKGROUND: PBSC collected following G-CSF priming lead to more rapid hemopoietic reconstitution (HR) after autologous transplantation than do unprimed BMstem cells. However, PBSC have a number of disadvantages compared with BM cells, including the need for an extended collection period and requirement for good venous access. METHODS: We retrospectively analysed our experience with an alternative source of hemopoietic stem cells, G-CSF primed BM. Fortyfour patients who underwent BM harvesting after 6 days' administration of G-CSF, at a dose of 5 microg/kg per day, were compared with an equal number who underwent standard (unprimed) BM harvesting. We also analysed HR after autologous transplantation in 16 patients who received unprimed BM, 18 who received G-CSF-primed BM and 14 who received PBSC. RESULTS: G-CSF-primed BM was collected more quickly (p<0.00005) and yielded a larger number of cells (p<0.0001) than unprimed BM. Consequently, larger numbers of cells were available for administration following transplantation with G-CSF-primed BM. The results of HR after transplantation with G-CSF primed BM were intermediate between those of unprimed BM and PBSC. For example, platelet independence (unsupported platelet count > or = 20 2 10(9)/L) occurred after 22 days with unprimed BM, 14 days with G-CSF-printed BM and 10 days with PBSC (p for trend <0.0001) and the mean number of days when platelet transfusions were given was 10, 6 and 3 respectively (p for trend <0.005). These results reflected transplant cell doses. CONCLUSION: G-CSF-primed BM is a valuable source of hemopoietic stem cells for autologous transplantation and a useful alternative to PBSC to certain circumstances.