Persistent problems of neutropenia and thrombocytopenia with peripheral blood stem cell transplantation.
We describe potential problems that may limit the usefulness of peripheral blood stem cells (PBSC) to facilitate the delivery of multiple cycles of high-dose chemotherapy. These include (1) cumulative myelotoxicity and (2) recurrent episodes of febrile neutropenia and a requirement for frequent platelet transfusions as a result of the stubborn persistence of a minimum of 7-9 days of absolute neutropenia and even longer durations of severe thrombocytopenia, despite utilization of PBSC. However, some of these problems may be overcome by shortening the duration of administration of the high-dose regimen with subsequent earlier reinfusion of the stem cell product. The adverse consequences of severe neutropenia could be overcome by the development of prophylactic neutrophil transfusions. These concepts are discussed with presentation of some preliminary data.
Spitzer
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Saint Louis University Health Sciences Center, Bone Marrow Transplantation and Medical Oncology and Hematology, MO 63110-0250.
Adkins
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DR
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001853:Bone Marrow / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D006086:Graft vs Host Disease / Q000503:physiopathology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology*; D009504:Neutrophils / Q000637:transplantation*; D010976:Platelet Count; D017713:Platelet Transfusion; D013921:Thrombocytopenia / Q000209:etiology*
D016179:Granulocyte Colony-Stimulating Factor