Do G-CSF mobilized, peripheral blood-derived stem cells from healthy, HLA-identical donors really engraft more rapidly than do G-CSF primed, bone marrow-derived stem cells? No!
For more than a decade, the notion that peripheral blood-derived stem cells engraft more rapidly than bone marrow-derived stem cells after high-dose therapy has dominated our thinking. Recently, reports that granulocyte colony-stimulating factor (G-CSF) induces a proteolytic marrow microenvironment have provided mechanistic support for that belief, compelling us to review our own experience of 29 consecutive transplants with HLA-identical blood and marrow stem cells. In contrast to several reported randomized controlled trials, we found marrow stem cells engraft just as rapidly (median day 11 for granulocytes over 500/microl and median day 17 for platelets over 20,000/microl) as blood stem cells (median day 12 and median day 19, respectively) if the donor is treated with G-CSF in the same manner before marrow harvest as the donor is treated with G-CSF before leukapheresis. These observations with healthy HLA-identical donors confirm the results of our prior randomized autotransplant study. We propose the concept that the level of activation of the stem cells (induced by G-CSF) determines engraftment kinetics and not the anatomical site of derivation.
Elfenbein
Gerald J
GJ
Blood and Marrow Transplant Program, Roger Williams Medical Center, Providence, RI 02908, USA. gelfenbein@rwmc.org
Sackstein
Robert
R
Oblon
David J
DJ
D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000592:standards; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000494:pharmacology; D006410:Hematopoiesis; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000187:drug effects; D006648:Histocompatibility; D006801:Humans; D007700:Kinetics; D007958:Leukocyte Count; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods* / Q000592:standards; D010976:Platelet Count; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D016179:Granulocyte Colony-Stimulating Factor