Engraftment Kinetics after High-Dose Chemotherapy and Autologous
Peripheral Stem Cell Transplantation
Mayer J., Kořístek Z.,
1
Pospíšil Z., Vášová I., Adam Z., Hájek R., Krejčí M.,
Král Z., Navrátil M., Vorlíček J.,
2
Bourková L.,
2
Matýšková M.,
3
Adler J.,
3
Vinklárková J., Klabusay M., Koutná I., Hoffová V., Schmitzová D.,
3
Janovská
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Abstract:
Background. Autologous peripheral blood stem cell transplantation (APBSCT) is gradually replacing autologous
bone marrow transplantation in many clinical settings. The key question is how to evaluate the quality of grafts. We
analyzed the relationship between hematopoietic reconstitution and characteristics of patients and grafts.
Methods and Results. Data from 95 APBSCTs were analyzed. Peripheral stem cells were obtained after
mobilization using anti-neoplastic chemotherapy followed by Neupogen (G-CSF). After high dose chemotherapy
and APBSCT, patients received Leucomax (GM-CSF). Patients were reinfused with a median of 6.1 x 10
6
(range
0.83-29.3) CD34+ cells/kg, and 25.1 x l0
4
(range 1.0-167.0) CFU-GM/kg of body weight. The median time to
engraftment was 12 days (both for granulocytes 1 x 10
9
/l and platelets 50 x 10
9
/l). We found a significant correlation
between the number of CD34+ cells and CFU-GM reinfused and also between their respective graft sizes and time
to leukocytes, platelets, and granulocytes recovery. We did not find a significant correlation between the number of
mononuclear cells reinfused and any analyzed parameter (time to engraftment, age, diagnosis, number of previous
chemotherapies, type of mobilization or high-dose regimen). However, administration of preparative high-dose
chemotherapy consisted of busulphan and cyclophosphamide was associated with the risk of a transient secondary
graft failure.
Conclusions. We conclude that the content of progenitors in PBSC grafts and time to booth leukocyte and platelet
recovery are best estimated by the number of CD34+ cells (not less than 1 x 10
6
/kg) and CFU-GM (not less than
1 x 10
4
/kg). The number of mononuclear cells in an autologous PBSC graft is not suitable and useful for prediction
of engraftment rate. There is probably no additional benefit of reinfusion of more than 8 - 10 x 10
6
CD34+ cells/kg
and/or 50 x 10
4
CFU-GM/kg, because hematopoietic recovery is not more rapid.
Key words:
autologous transplantation, peripheral stem cells CD34+, CFU-GM.
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