Autologous stem cells derived from the peripheral blood compared to standard bone marrow transplant; time to engraftment: a systematic review.
Lymphoma patients who require high dose chemotherapy are 'rescued' by reinfusion of stem cells to repopulate their bone marrow and minimise the risk of fatal infections or haemorrhage. This review evaluated the evidence for the use of stem cells derived from the peripheral blood to speed the engraftment of neutrophil and platelets when compared to standard bone marrow transplant. A systematic search of the Cochrane Library, Medline and Embase was carried out to identify randomised controlled trials comparing haematological recovery following these two interventions which met predetermined inclusion and exclusion criteria. Four studies were critically appraised and found to follow heterogenous protocols but were otherwise of satisfactory quality. All four studies demonstrated an advantage of peripheral blood stem cell transplantation over bone marrow transplantation in terms of neutrophil recovery and three out of four demonstrated the same trend for platelet engraftment. In sum, there is evidence to support the use of peripheral blood stem cell transplantation for this population of lymphoma patients. Nurses can share this information confidently with patients and other staff. However, a more extensive review of studies which have investigated the association between extended neutrophil and platelet recovery and length of hospitalisation, number of septic neutropenic episodes and cost reduction is needed to give a fuller picture of the effects for treatment.
Lewis
Ally
A
Haemato-oncology Clinical Nurse Specialist, Dartford & Gravesham NHS Trust Kent, Darent Valley Hospital, Kent, UK. ally.lewis@dag-tr.sthames.nhs.uk
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000451:nursing / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D007902:Length of Stay; D018655:Lymphocyte Count; D008223:Lymphoma / Q000097:blood / Q000628:therapy*; D009504:Neutrophils; D018579:Patient Selection; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000451:nursing / Q000592:standards*; D010976:Platelet Count; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design / Q000592:standards; D013997:Time Factors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000451:nursing / Q000592:standards*; D016896:Treatment Outcome
D000970:Antineoplastic Agents