RESUMO
We studied hematopoietic and immune recovery in 40 subjects receiving autologous bone marrow (ABMT) or blood stem cell transplants (ABSCT). Supportive care, transplant-related morbidity, duration of hospitalization and cost were also considered. ABSCT was associated with more rapid recovery of all hematopoietic lineages than was ABMT. However, kinetics of immune recovery were similar between the groups. In the ABSCT group, there was a correlation between numbers of blood progenitor cells infused and the rate of hematopoietic recovery. The accelerated hematopoietic recovery following ABSCT correlated with less morbidity, fewer transfusions, briefer hospitalization and lower cost than ABMT.
Assuntos
Células Sanguíneas/transplante , Transfusão de Sangue Autóloga , Transplante de Medula Óssea/patologia , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto , Idoso , Células Sanguíneas/imunologia , Células Sanguíneas/patologia , Transplante de Medula Óssea/imunologia , Criança , Pré-Escolar , Feminino , Hematopoese , Células-Tronco Hematopoéticas/imunologia , Células-Tronco Hematopoéticas/patologia , Humanos , Imunoglobulinas/sangue , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Neoplasias/patologia , Neoplasias/cirurgia , gama-Globulinas/metabolismoRESUMO
The level of peripheral blood granulocyte-monocytic precursors (PB CFU-GM) was studied serially in 10 adult patients with acute lymphoblastic leukaemia (ALL) in early complete remission after induction chemotherapy. The patients were distributed into 2 main groups according to the morphological French-American-British classification: ALL2 and ALL3. Collection of circulating stem cells (CSC) by cytapheresis was performed in 7 of these 10 patients with satisfactory results, except in 2 ALL2 patients, both of whom had chromosome translocation, which could have been a contributing factor. It appears, moreover, that even with 2 or 3 inductions courses, the more intensive the chemotherapy regimen in previously non-treated patients, the higher the peak of PB CFU-GM and the better the collection of CSC. The measurement of CFU-GM is certainly a less effective indicator of pluripotent stem cells in blood than in bone marrow, and it is probably necessary, but sufficient, to inject 5 times more CFU-GM than normally injected in marrow transplants to allow prompt and stable engraftment. The feasibility of this new graft technique seems for the moment undeniable, the main problem in ALL is the risk of relapse.
Assuntos
Transplante de Medula Óssea , Células-Tronco Hematopoéticas/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adulto , Ensaio de Unidades Formadoras de Colônias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologiaRESUMO
The level of circulating myeloid progenitor cells (CFU-G), considered to be a good index of the quantity of circulating hemopoietic stem cells, was measured in the peripheral blood of 5 patients with acute leukemia as they entered first remission. High levels of circulating CFU-G were found in 4 of these 5 patients, depending on the intensity and the number of courses of induction chemotherapy. Repeated cytaphereses were done on 3 of these patients in order to collect and to cryopreserve circulating stem cells, to be used later for autologous transplantation. We propose a model which calculates the number of cytaphereses sufficient to obtain a level of 10(5) CFU-G/kg of weight, considered necessary to achieve a good hemopoietic reconstitution after transplantation.