RESUMEN
BACKGROUND: The composition of the graft used for allogeneic hematopoietic stem cell transplantation (HSCT) is important for the treatment outcome. Different apheresis devices may yield significant differences in peripheral blood stem cell graft cellular composition. We compared stem cell grafts produced by Cobe Spectra (Cobe) and Spectra Optia (Optia) with use of the mononuclear cell (MNC) protocol, and evaluated clinical outcome parameters such as graft-versus-host disease (GvHD), transplant-related mortality (TRM), relapse, and overall survival. STUDY DESIGN AND METHODS: During 5 years, 31 Cobe Spectra and 40 Spectra Optia grafts were analyzed for CD34, CD3, CD4, CD8, CD19, and CD56 cell content. Clinical outcome parameters were correlated and compared between the two patient groups using different apheresis devices. RESULTS: Optia grafts contained fewer lymphocytes compared to Cobe (p < 0.001). Optia grafts had a significantly lower incidence of acute GvHD Grades II through IV (Cobe 45% vs. Optia 23%; p = 0.039) and TRM (16% vs. 2.5%; p < 0.05) but higher chronic GvHD (32% vs. 67%; p = 0.005) compared to Cobe grafts. Finally, the multivariate analysis showed a significant correlation among the different apheresis devices and both acute GvHD II through IV and severe chronic GvHD. The multivariate analysis also showed a significant correlation between the CD3+ cell dose and the incidence of severe acute GvHD. CONCLUSION: Optia-obtained grafts yielded a lower acute GvHD Grades II-IV and TRM risk, but had no impact on relapse or overall survival in this study. Understanding and further improvement of peripheral blood stem cell (PBSC) apheresis techniques may be used in the future to personalize HSCT by, for example, fine-tuning the GvHD incidence.
Asunto(s)
Eliminación de Componentes Sanguíneos/instrumentación , Enfermedad Injerto contra Huésped/etiología , Donantes de Tejidos , Trasplante Homólogo/efectos adversos , Enfermedad Aguda , Adulto , Antígenos CD/sangre , Eliminación de Componentes Sanguíneos/normas , Complejo CD3/sangre , Femenino , Enfermedad Injerto contra Huésped/mortalidad , Humanos , Incidencia , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Trasplante de Células Madre de Sangre Periférica/métodos , Trasplante de Células Madre de Sangre Periférica/mortalidad , Recurrencia , Análisis de Supervivencia , Trasplante Homólogo/mortalidadRESUMEN
BACKGROUND AND OBJECTIVE: Storage of platelets > 5 days provides improved availability, logistical management and decreased outdating. Promising results on in vitro parameters and on in vivo post-transfusion recovery and survival of autologous platelets in healthy volunteers have earlier been shown. To provide additional verification, randomized patient transfusion studies are needed. MATERIALS AND METHODS: Sixty allogeneic haematopoietic progenitor cell transplant recipients were randomized to receive buffy-coat (BC) platelets stored in platelet additive solution (PAS) for 1-5 days the first time a prophylactic transfusion was needed after transplantation, followed the second time by platelets stored for 6-7 days or vice versa. The corrected count increment (CCI) for 1 and 24 h were calculated. RESULTS: CCI 1 h and CCI 24 h were higher for platelets stored 1-5 days as compared to 6-7 days, 10.4 +/- 5.1 vs. 7.4 +/- 3.8 (P < 0.001) and 5.4 +/- 4.1 vs. 2.6 +/- 2.6 (P < 0.001), respectively. Time to next platelet transfusion was significantly longer after a transfusion of platelets stored for 1-5 days as compared to platelets stored for 6-7 days: 2.2 +/- 1.1 vs. 1.6 +/- 0.8 days, respectively (P < 0.005). No differences in bleeding events and no transfusion reaction were recorded. CONCLUSION: The advantage of an extension of platelet storage time beyond day 5 should be balanced against the increased need for platelet transfusions that may occur and the conceivable risk of transfusion failure.
Asunto(s)
Plaquetas/efectos de los fármacos , Conservación de la Sangre/métodos , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Soluciones Farmacéuticas/farmacología , Transfusión de Plaquetas , Cuidados Posoperatorios , Complicaciones Posoperatorias/terapia , Trombocitopenia/terapia , Adolescente , Adulto , Conservación de la Sangre/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/cirugía , Transfusión de Plaquetas/métodos , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Trombocitopenia/complicaciones , Factores de Tiempo , Trasplante Homólogo , Adulto JovenAsunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Incompatibilidad de Grupos Sanguíneos/inmunología , Transfusión Sanguínea , Política Organizacional , Trasplante de Células Madre , Quimera por Trasplante/inmunología , Trasplante Homólogo/inmunología , Sistema del Grupo Sanguíneo ABO/genética , Anemia Hemolítica/etiología , Anemia Hemolítica/inmunología , Anemia Hemolítica/prevención & control , Supervivencia de Injerto , Humanos , Donantes de Tejidos , Reacción a la Transfusión , Acondicionamiento PretrasplanteRESUMEN
Allogeneic hematopoietic stem cell transplantation is associated with several complications and risk factors, for example, graft versus host disease (GVHD), viral infections, relapse, and graft rejection. While high levels of CD3+ cells in grafts can contribute to GVHD, they also promote the graft versus leukemia (GVL) effect. Infusions of extra lymphocytes from the original stem cell donor can be used as a treatment after transplantation for relapse or poor immune reconstitution but also they increase the risk for GVHD. In peripheral blood, 95% of T-cells express the αß T-cell receptor and the remaining T-cells express the γδ T-cell receptor. As αß T-cells are the primary mediators of GVHD, depleting them from the graft should reduce this risk. In this pilot study, five patients transplanted with HLA-matched related and unrelated donors were treated with αß T-cell depleted stem cell boosts. The majority of γδ T-cells in the grafts expressed Vδ2 and/or Vγ9. Most patients receiving αß-depleted stem cell boosts increased their levels of white blood cells, platelets, and/or granulocytes 30 days after infusion. No signs of GVHD or other side effects were detected. A larger pool of patients with longer follow-up time is needed to confirm the data in this study.
Asunto(s)
Rechazo de Injerto/inmunología , Trasplante de Células Madre Hematopoyéticas/métodos , Receptores de Antígenos de Linfocitos T alfa-beta/inmunología , Linfocitos T/inmunología , Adulto , Recuento de Células Sanguíneas , Preescolar , Femenino , Citometría de Flujo , Rechazo de Injerto/etiología , Rechazo de Injerto/metabolismo , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/metabolismo , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Prueba de Histocompatibilidad , Humanos , Depleción Linfocítica , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reacción en Cadena de la Polimerasa , Receptores de Antígenos de Linfocitos T alfa-beta/metabolismo , Receptores de Antígenos de Linfocitos T gamma-delta/genética , Receptores de Antígenos de Linfocitos T gamma-delta/inmunología , Receptores de Antígenos de Linfocitos T gamma-delta/metabolismo , Linfocitos T/metabolismo , Factores de Tiempo , Trasplante Homólogo , Resultado del Tratamiento , Donante no Emparentado , Adulto JovenRESUMEN
Autologous stem cell transplantation is standard treatment for newly diagnosed younger patients with multiple myeloma and for relapsed or refractory Hodgkin or non-Hodgkin lymphoma. Patient characteristics influencing the yield from stem cell collection and time from transplant to platelet recovery were retrospectively analyzed in 630 consecutive patients, attempting to define adequate amounts of CD34+ cells to collect and reinfuse; 509/630 patients (81%) mobilized the requested CD34+ cell number. Factors influencing the harvest yield were age (P < 0.001) and gender, where 85% of men and 78% of women (P < 0.02) attained the requested stem cell amount. Time to platelet recovery was significantly faster for multiple myeloma patients compared to all other diagnoses (14.6 days compared to 19.8, P < 0.0001). Multiple myeloma patients were older than lymphoma patients but received stem cell transplant up-front as opposed to second line therapy for other patient groups. Multivariate analysis revealed that the most important factor influencing platelet recovery was diagnosis, followed by the amount of reinfused CD34+ cells (P < 0.001, P < 0.05). Blood group O+ had the fastest platelet recovery, whereas blood group A harvested the highest cell amounts. In conclusion, we demonstrate a significant importance of the number of reinfused CD34+ cells on the time to platelet recovery.