A single apheresis procedure in the donor may be enough to complete an allograft using the "Mexican method" of non-ablative allografting.
BACKGROUND
Since 1999, in Mexico we have been using a regimen to conduct allografts that involves non-myeloablative conditioning and peripheral blood stem cells (PBSC) and have introduced some changes with the main goal of decreasing the cost of the procedure.


METHODS
We analysed the salient apheresis features of a group of 175 allogeneic peripheral blood stem cell transplants conducted in two institutions in a 7-year period. The grafts were conducted using the "Mexican" non-myelo ablative conditioning regimen employing oral busulphan, i.v. cyclophosphamide and i.v. fludarabine. In all instances, the apheresis machine employed was the Baxter CS3000 Plus and donors were mobilised with filgrastim. The apheresis procedures were performed on days 0, +1 and +2, the end-point of collection being 5,000 mL of blood/m2 in each procedure. Three apheresis sessions were planned but the number was adjusted according to the cell yield.


RESULTS
The final number of allografted CD34 cells ranged between 0.5 and 25.4 x 10(6)/Kg of the recipient's body weight (median, 5.2 x 10(6)/Kg). One to three apheresis procedures were needed to obtain a product containing more than 0.5 x 10(6) CD34 cells/Kg of the recipient, the median being two procedures; in 72 cases (41%) a single apheresis procedure was sufficient to obtain the target number of CD34 cells. The volumes of apheresis ranged between 50 and 600 mL (median, 400 mL).


CONCLUSIONS
Since the median cost of each apheresis procedure is 900 USD, the fact that two apheresis procedures was spared in 72 cases and one apheresis was spared in another 65 cases, led to a total saving of approximately 188,100 USD. It can be concluded that, in many cases, allogeneic transplants can be completed with a single apheresis session and that there are considerable financial benefits from this practice.
Ruiz-Delgado
Guillermo J
GJ
Centro de Hematología y Medicina Interna de Puebla, 8B Sur 3710, 72530 Puebla, PUE - Mexico. gruiz2@clinicaruiz.com
Gutiérrez-Riveroll
Karla I
KI
Gutiérrez-Aguirre
César H
CH
Gómez-Almaguer
David
D
Eyzaguirre-Zapata
Renee
R
Priesca-Marin
Manuel
M
González-Carrillo
Martha L
ML
Ruiz-Argüelles
Guillermo J
GJ
D000741:Anemia, Aplastic / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001781:Blood Component Removal / Q000191:economics / Q000379:methods*; D001782:Blood Donors; D002066:Busulfan / Q000008:administration & dosage; D017115:Catheter Ablation; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D008800:Mexico; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011994:Recombinant Proteins; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D000069585:Filgrastim