title: Collection and transplantation of peripheral blood stem cells in very small children weighting 20 kg or less.
abstract: The safety and efficacy of harvesting peripheral blood hematopoietic stem cells (PBSC) were evaluated in 38 children weighing 20 kg or less, with the smallest patient weighing 7 kg. The patients had a median age of 42 months and included 26 children with acute leukemias or lymphoma and 12 with various solid tumors. A total of 81 aphereses were performed, mostly in the recovery phase of chemotherapy, with or without granulocyte colony-stimulating factor, using a CS-3000 cell separator and regular procedure no. 3. Blood was withdrawn at a mean rate of 30 mL/min (range, 17 to 46 mL/min) through a temporary radial arterial catheter (20 to 24 guage) and returned through a larger catheter in a peripheral vein. Morbidity related to PBSC harvest was low and all aphereses were completed within 3 hours. The volume of blood per kilogram processed for each apheresis ranged from 85 to 615 mL (median, 270 mL). The median number of colony-forming units--granulocyte-macrophage (CFU-GM) and CD34+ cells collected were, respectively, 34 x 10(4)/kg and 15 x 10(6)/kg per apheresis and 126 x 10(4)/kg and 31 x 10(6)/kg per patient. Thirty-three patients (87%) required only a single apheresis to collect the minimum requirement of 10 x 10(4) CFU-GM/kg, including 28 patients (74%) from whom 30 x 10(4) CFU-GM/kg was obtained in a single apheresis. Twenty-three of the patients subsequently underwent autografts with PBSC. The median number of days required to achieve an absolute granulocyte count of 0.5 x 10(9)/L and a platelet count of 50 x 10(9)/L were, respectively, 10 (range, 6 to 15) and 14 (range, 9 to 46). The patients remained dependent on platelet transfusion support for a median of 10 days (range, 5 to 35). Thus, harvesting PBSC in very small children with active cancers is effective and safe and does not involve the risk of anesthesia or multiple invasive marrow aspirations.
authors.affiliation: Department of Pediatrics, University Hospital of Tokushima, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Takaue
authors.forename: Y
authors.initials: Y
authors.lastname: Kawano
authors.forename: T
authors.initials: T
authors.lastname: Abe
authors.forename: Y
authors.initials: Y
authors.lastname: Okamoto
authors.forename: T
authors.initials: T
authors.lastname: Suzue
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.forename: S
authors.initials: S
authors.lastname: Saito
authors.forename: J
authors.initials: J
authors.lastname: Sato
authors.forename: A
authors.initials: A
authors.lastname: Makimoto
authors.forename: R
authors.initials: R
authors.lastname: Nakagawa
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001781:Blood Component Removal / Q000379:methods*; D001793:Blood Preservation; D001835:Body Weight; D001855:Bone Marrow Diseases / Q000139:chemically induced / Q000628:therapy; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003114:Colony-Forming Units Assay; D003131:Combined Modality Therapy; D000075202:Contraindications; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000097:blood / Q000188:drug therapy; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy / Q000601:surgery; D017713:Platelet Transfusion; D012189:Retrospective Studies; D012449:Safety
chemical_list: D003561:Cytarabine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin