title: Granulocyte colony-stimulating factor mobilized whole blood containing over 0.3 x 106/kg CD34+ cells is a sufficient graft in autologous transplantation for relapsed non-Hodgkin's lymphoma.
abstract: The feasibility of unprocessed, granulocyte colony-stimulating factor (G-CSF)-mobilized whole blood (WB) as an alternative stem cell source for autologous stem cell transplantation was studied. Forty-seven relapsed non-Hodgkin's lymphoma (NHL) patients entered the study. After two or three ifosfamide, methotrexate and etoposide (IMVP) courses, 1 l of G-CSF-mobilized WB was collected and stored refrigerated for 72 h. Meanwhile, BAM conditioning was given: BCNU (carmustine) 300 mg/m(2), high-dose cytarabine 6000 mg/m(2) and melphalan 140 mg/m(2). Toxicity, haematological recovery and survival were assessed and compared with peripheral blood stem cell transplantation (PBSCT) and bone marrow transplantation (BMT) reference groups. High-dose G-CSF (2 x 12 microg/kg/d) gave the best mobilization results. Haematological recovery was related to the WB CD34+ content. A CD34+ threshold of >or= 0.3 10(6)/kg, obtained in 90% of patients using high-dose G-CSF, correlated with adequate recovery: absolute neutrophil count (ANC) > 0.5 x 10(9)/l: median 12 d (range 9-19). Platelet recovery > 20 and > 50 x 10(9)/l was 19 (11-59) and 30 d (14 not reached) respectively. Overall survival of patients < 60 years was 57% at 4 years and event-free survival was 32%. Survival was comparable with PBSCT and BMT after BEAM (BCNU, etoposide, cytarabine, melphalan). Remarkably, haematological recovery after BAM + WB was rapid and comparable (ANC) or slightly prolonged (platelets) in comparison with BEAM + PBSCT, despite a 10-20 times lower CD34+ cell dose in the WB graft. In conclusion, transplantation of WB containing >or= 0.3 x 10(6)/kg CD34+ cells after BAM conditioning is a safe procedure, and offers a fully equivalent and less costly alternative for PBSC.
authors.affiliation: Department of Haematology, VU Medical Centre, Amsterdam, the Netherlands. Hematol@azvu.nl
authors.forename: Andries R
authors.initials: AR
authors.lastname: Jonkhoff
authors.forename: Arne M
authors.initials: AM
authors.lastname: De Kreuk
authors.forename: Gaby
authors.initials: G
authors.lastname: Franschman
authors.forename: Johannes
authors.initials: J
authors.lastname: Van Der Lelie
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Schuurhuis
authors.forename: Angelika M
authors.initials: AM
authors.lastname: Dräger
authors.forename: Sonja
authors.initials: S
authors.lastname: Zweegman
authors.forename: Peter C
authors.initials: PC
authors.lastname: Huijgens
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Ossenkoppele
mesh_terms: D000328:Adult; D018952:Antigens, CD34; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013601:T-Lymphocytes / Q000276:immunology*; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor