Use of peripheral blood stem cells to accelerate hemopoietic recovery following autologous bone marrow transplantation.

Twenty-one patients with high risk non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Nine out of 21 patients received in addition to bone marrow (BM) cells also peripheral blood (PB) cells collected by leucapheresis performed in the recovery phase after high-doses of either cyclophosphamide or etoposide (7 patients), or after ara-C (2 patient). All patients receiving BM + PB cells had ABMT as salvage therapy following extensive relapse or progression of their disease. The addition of PB cells to BM cells allowed a significantly faster recovery after ABMT. Median time to reach WBC greater than 1,000/microL was 14 days versus 20.5 days for patients receiving BM only. Furthermore, a reduced requirement of supportive care and a shorter period of isolation was observed. These results confirm that PB cells combined with BM cells allow a prompt hematopoietic reconstitution after myeloablation. In addition, the data demonstrate the efficacy of PB cells collected after various cytotoxic drugs, even in patients previously exposed to cytoreductive regimens.

Plasma exchange-induced biological stress of the Hagemann-mediated systems: results of contact activation and plasma substitution.

Plasma exchange can induce changes in the biological systems of coagulation, fibrinolysis, complement and kinins, either by contact activation or plasma substitution. In order to know which of the two is responsible, the actual initial and final values and theoretical calculated final values were compared. Fibrinogen, Antithrombin III and platelets fell more than expected, and there was a significant increase in Platelet-Factor four and Betathromboglobulin which was greater than would produced by plasma substitution alone. Fibrinolysis is shortened and white cells rise. Complement and kinins were not significantly changed. During plasma exchange, contact activation actually triggers coagulo-fibrinolytic pathway and stresses cellular components.

Activation of the coagulation system and leukocytes kinetics in plasma exchange.

The activation of the coagulation system--commonly occurring in other extracorporeal circulation--is still debated, in plasma exchange (PE), data being conflicting due to the different types of replacement fluid used in 25 patients treated by PE using a discontinuous plasma separator (14 with freshly-frozen plasma, 8 with half plasma half 5% albumin, 3 with only 5% albumin). The occurrence of leukocytes stress is proved by their marked increase at the end of the procedure while the platelet fall is superimposable to the HTC fall. A coagulation-fibrinolytic activation seems to be demonstrated by plasma increase in endoplatelet constituents, fibrinogen and antithrombin III consumption, and shortening in fibrinolytic tests, but caution must be made in interpreting these results because the donor's plasma units show high levels of platelet endogranular constituents and a wide variable range of coagulation-related proteins, which can interfere with an appropriate evaluation of the results.