Peripheral blood progenitor cell transplantation

NEUPOGEN Filgrastim (G-CSF) Amgen Chemotherapy-induced neutropenia, bone marrow transplantation, chronic severe neutropenia, peripheral blood progenitor cell transplant... 

Filgrastim (r-metHuG-CSF) Neupogen (Amgen) Febrile neutropenias owing to myelosuppressive chemotherapy myeloid reconstitution after bone marrow transplantation severe chronic neutropenia peripheral blood progenitor cell transplant induction and consolidation therapy in AML... 

Ketterer N, Espinouse D, Chomarat M, et al. Infections following peripheral blood progenitor cell transplantation for lymphoproliferative malignancies Etiology and potential riskfactors. Am J Med 1999 106 191-197. 

Smith TJ, Hillner BE, Schmitz N, et al. Economic analysis of a randomized clinical trial to compare filgrastim-mobilized peripheral blood progenitor cell transplantation with autologous bone marrow transplantation in patients with Hodgkin s and non-Hodgkin s lymphoma. J CUn Oncol 1997 15 5-10. 

Reddy RL. Mobilization and collection of peripheral blood progenitor cells for transplantation. Transfus Apher Sci 2005 32 63-72. 

Leukine Sargramostim (GM-CSF) Immunex Autologous bone marrow transplantation, neutropenia resulting from chemotherapy, peripheral blood progenitor cell mobilization, and transplantation... 

Autologous bone marrow transplant Neutropenia resulting from chemotherapy Allogeneic bone marrow transplant Peripheral blood progenitor cell mobilization Leukemias (leukopenias and fungal infection) March 1991 Sept. 1995 Nov. 1995 Dec. 1995 Nov. 1996... 

E. Therapentic response In clinical trials Leukine was safe and effective in adult patients with acute myeloid leukemia, reducing the duration of neutropenia as well as chemotherapy-associated mortality and morbidity. Leukine, administered alone or after myeloablative chemotherapy, enhances the number of circulating peripheral blood progenitor cells, allowing harvest for autologous transplantation. 

Stem cell transplantation Mobilization of peripheral blood progenitor cells (PBPCs) Patients with nonmyeloid malignancies treated with stem cell transplantation... 

Dreger P, Kloss M, Petersen B, Haferlach T, et al. 1995. -Autologous progenitor cell transplantation Prior exposure to stem cell-toxic drugs determines yield and engraft-ment of peripheral blood progenitor cell but not of bone marrow grafts. Blood. 86 3970-3978. 

In a randomized, double-blind study, oral granisetron (1 mg) was more effective than intravenous granisetron (1 mg) in preventing emesis caused by high-dose chemotherapy in 51 patients who underwent peripheral blood progenitor cell or bone-marrow transplantation (44). There was no significant difference in adverse events. The more frequent were headache, diarrhea, extrapyra-midal symptoms, and sedation. 

Abang AM, Takemoto MH, Pham T, Mandanas RA, Roy V, Selby GB, Carter TH. Efficacy and safety of oral granisetron versus i.v. granisetron in patients undergoing peripheral blood progenitor cell and bone marrow transplantation Anticancer Drugs 2000 ll(2) 137-42. 

Strom SS. Long-term follow-up of normal peripheral blood progenitor cell donors treated with filgrastim no evidence of increased risk of leukemia development. Bone Marrow Transplant 2002 30(10) 661-3. 

MHC major histocompatibility complex MLC mixed lymphocyte culture MLR mixed lymphocyte reaction MUD matched unrelated donor NMDP National Marrow Donor Program NMT nonmyeloablative transplant PBPC peripheral blood progenitor cell PBSC peripheral blood stem cell PCR polymerase chain reaction TBI total body irradiation UCB umbilical cord blood VOD (hepatic) veno-occlusive disease... 

Glaspy JA. Economic considerations in the use of peripheral blood progenitor cells to support high-dose chemotherapy. Bone Marrow Transplant 1999 23(Suppl 2) s21-s27. 

Support for peripheral blood progenitor cell mobilization and transplantation Becaplermin Lower extremity diabetic neuropathic ulcers... 

More than 0.5x10 / neutrophils are achieved at a median of 10-14 days after transplantation of peripheral blood progenitor cells, 21-28 days after marrow infusion, and 25-35 days when umbilical cord blood is the hematopoietic source. A self-sustained platelet count above 20x10 / is usually reached 5 days to 3 weeks after neutrophil recovery. Full immune reconstitution is slow and takes several months. CD4+ cell counts are low after transplantation. B-cell production and function are also impaired after the procedure. New ontogeny of the immune system after allogeneic transplantation requires vaccination against the most common pathogens, once the ability to effectively produce antibodies is restored. 

G-CSF is widely used to mobilise bone marrow stem cells into the peripheral blood to support both autologous and allogeneic peripheral blood progenitor transplantation. The use of peripheral blood progenitors as opposed to bone marrow progenitors is associated with earlier neutrophil and platelet recovery, fewer red cell transfusions and earlier discharge from hospital. 

Egress of more mature cells from the bone marrow occurs through the endothelial cell barrier. Release of cells such as neutrophils may be stimulated by complement, steroids, or endotoxin. Immature (progenitor) cells that may ultimately become any one of the blood cellular components can be mobilized from the bone marrow into peripheral blood by the administration of a cytotoxic chemotherapy drug (e.g., cyclophosphamide) or a colony-stimulating factor (G-CSE or GM-CSE). This process is commonly referred to as priming the bone marrow for peripheral blood progenitor or stem cell transplantation (see Chap. 134). 

---