title: Transplantation of enriched and purged peripheral blood progenitor cells from a single apheresis product in patients with non-Hodgkin's lymphoma.
abstract: High-dose chemotherapy with or without radiotherapy followed by autologous transplantation of hematopoietic progenitor cells is an effective treatment for patients with high-risk or relapsed non-Hodgkin's lymphoma. Chemotherapy and/or hematopoietic growth factors have been used to mobilize progenitor cells in the peripheral blood for transplantation. However, the mobilized blood cell products have been found to be frequently contaminated with tumor cells, and techniques have not been developed to purge tumor cells from these products. In addition, the minimum number of hematopoietic progenitor cells required for engraftment has not yet been fully elucidated. We treated 21 patients with a single infusion of cyclophosphamide (4 g/m2) followed by daily administration of granulocyte colony-stimulating factor (G-CSF). After recovery of the white blood cell count, a single 3-hour apheresis collection was performed. The apheresis product was then applied to a discontinuous Percoll gradient. The low-density fractions resulting from this separation procedure were enriched for CD34+ progenitor cells (total cell yield, 19.5%; CD34+ cell recovery, 81.2%). These enriched cellular products were treated with a panel of anti-B cell or anti-T cell monoclonal antibodies and complement in an effort to remove residual tumor cells. After treatment of the patient with myeloablative therapies, the enriched and purged cells were reinfused. Hematologic recovery was rapid, with median neutrophil engraftment in 10 days [absolute neutrophil count (ANC), greater than 0.5 x 10(9)/L] and 11 days (ANC, greater than 1.0 x 10(9)/L). Median platelet transfusion independence required 13 days. The rapidity of multilineage engraftment correlated with the number of CD34+ cells per kilogram that were infused. Patients who received more than 2 x 10(6) CD34+ cells per kilogram had rapid hematologic engraftment, whereas those patients transplanted with less than 2 x 10(6) CD34+ cells per kilogram had slower platelet recovery. Modeling studies using a lymphoma cell line with a t(14; 18) chromosomal translocation demonstrated the successful removal of tumor cells assayed using the polymerase chain reaction (PCR) after the processing and purging. Four of the 21 patients had PCR-detectable lymphoma cells in the bone marrow and peripheral blood; however, the enriched and purged blood products reinfused in all four did not contain detectable tumor cells.(ABSTRACT TRUNCATED AT 400 WORDS)
authors.affiliation: Department of Medicine, Stanford University School of Medicine, CA, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Negrin
authors.forename: C R
authors.initials: CR
authors.lastname: Kusnierz-Glaz
authors.forename: B J
authors.initials: BJ
authors.lastname: Still
authors.forename: J R
authors.initials: JR
authors.lastname: Schriber
authors.forename: N J
authors.initials: NJ
authors.lastname: Chao
authors.forename: G D
authors.initials: GD
authors.lastname: Long
authors.forename: C
authors.initials: C
authors.lastname: Hoyle
authors.forename: W W
authors.initials: WW
authors.lastname: Hu
authors.forename: S J
authors.initials: SJ
authors.lastname: Horning
authors.forename: B W
authors.initials: BW
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D018952:Antigens, CD34; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001781:Blood Component Removal; D016465:Bone Marrow Purging; D002330:Carmustine / Q000494:pharmacology / Q000627:therapeutic use; D002883:Chromosomes, Human, Pair 14 / Q000648:ultrastructure; D002887:Chromosomes, Human, Pair 18 / Q000648:ultrastructure; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology / Q000627:therapeutic use; D006410:Hematopoiesis / Q000187:drug effects; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000235:genetics / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000648:ultrastructure; D016133:Polymerase Chain Reaction; D012074:Remission Induction; D016879:Salvage Therapy; D014178:Translocation, Genetic; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine