Peripheral blood progenitor cell mobilization and collection in 42 patients with primary systemic amyloidosis.
BACKGROUND
High-dose chemotherapy followed by an inoculum of autologous peripheral blood progenitor cells (PBPCs) can improve survival in patients affected with primary systemic amyloidosis (AL). It has been documented, however, that the morbidity and mortality of PBPC mobilization and collection in this setting are higher than in patients with other diseases. To minimize the mobilization and collection-related risks, we developed a multidisciplinary approach involving different specialists to manage AL patients with predominant heart and renal involvement.


METHODS
We report our experience in 42 patients (23 men, 19 women; median age, 51.2 years; range, 28-68 years) with AL who underwent PBPC mobilization and collection. Twenty of the 42 patients (47.6%) had cardiac involvement and 35 of 42 (83.3%) renal involvement. Thirty-three patients (78.5%) were mobilized with granulocyte-colony-stimulating factor (G-CSF) alone (10 microg/kg) and 9 (21.4%) with cyclophosphamide (CTX) (3 g/m(2)) plus G-CSF (10 microg/kg).


RESULTS
The median number of collections per patient after either G-CSF or CTX plus G-CSF was 1.8 (range, 1-3). The median number of CD34+ cells collected in patients mobilized with G-CSF alone was 8.2 x 10(6) per kg (range, 1.35 x 10(6)-21.3 x 10(6)/kg) and in patients mobilized with CTX plus G-CSF it was 8.9 x 10(6) per kg (range, 5.5 x 10(6)-14.9 x 10(6)/kg). Forty of the 42 (95.2%) patients produced the minimum required CD34+ cell target dose (4 x 10(6)/kg). The overall rate of morbidity during the collections was 50 percent (21/42 patients): 18 patients (42.8%) had asymptomatic hypotension, 1 (2.4%) had symptomatic hypotension with nausea and vomiting, and 2 (4.7%) experienced a life-threatening hypotensive episode. There were no procedure-related deaths.


CONCLUSIONS
Our multidisciplinary approach was effective in limiting the serious side effects related to PBPC mobilization and collection in AL patients.
Perotti
Cesare
C
Immunohaematology and Transfusion Service, Center for Transplant Immunology, Pavia, Italy. c.perotti@smatteo.pv.it
Del Fante
Claudia
C
Viarengo
Gianluca
G
Perlini
Stefano
S
Vezzoli
Monia
M
Rodi
Giuseppe
G
Palo
Alessandra
A
Bergamaschi
Paola
P
Salvaneschi
Laura
L
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000097:blood*; D009202:Cardiomyopathies / Q000097:blood*; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015994:Incidence; D007674:Kidney Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012720:Severity of Illness Index; D013048:Specimen Handling / Q000009:adverse effects