Allogeneic Peripheral Blood Stem Cell Transplantation in Hematological Malignancies: Stem Cell Mobilization with GM-CSF alone or a combination of GM-CSF and G-CSF from Normal Healthy Donors.
- Author:
Dong Seok KWAK
1
;
Young Taek LEE
;
Yee Soo CHAE
;
Kwang Woon SEO
;
Sung Won PARK
;
Jin Ho BAEK
;
Jong Gwang KIM
;
Dong Hwan KIM
;
Jin Tae JUNG
;
So Hyang PARK
;
Sang Kyun SOHN
;
Jang Soo SUH
;
Kyu Bo LEE
Author Information
1. Department of Internal Medicine, Kyungpook National University, School of Medicine, Taegu, Korea. sksohn@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Allogeneic PBSCT;
GM-CSF;
GVHD;
Stem cell mobilization
- MeSH:
Blood Platelets;
Cytokines;
Exanthema;
Granulocyte Colony-Stimulating Factor*;
Granulocyte-Macrophage Colony-Stimulating Factor*;
Headache;
Hematologic Neoplasms*;
Hematopoietic Stem Cell Mobilization*;
Humans;
Incidence;
Leukapheresis;
Liver;
Lymphocytes;
Myalgia;
Peripheral Blood Stem Cell Transplantation*;
Siblings;
Skin;
Stem Cells*;
Tissue Donors*
- From:Korean Journal of Hematology
2001;36(1):25-34
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) has been used in normal heathy donors to mobilize hematopoietic progenitors. Recently, it was reported that an addition of granulocyte-macrophage-CSF (GM-CSF) mobilized more primitive CD34+ subsets than did G- CSF alone. We investigated the result of the allogeneic peripheral blood stem cell transplantation (PBSCT) with stem cells mobilized with GM-CSF alone or a combination of GM-CSF and G-CSF from normal healthy donors in hematological malignancies. METHODS: Twenty-nine patients with hematologic malignancies had allogeneic PBSCT from normal sibling donors. Nine healthy donors were mobilized with GM-CSF (Leucogen (R)) alone and 20 with a combination of GM-CSF and G-CSF (Leucostim (R)). After 5~8 days of cytokine treatment, PBSCs were collected by large volume leukapheresis and analyzed. RESULTS: Stem cells were collected from the HLA matched normal healthy sibling donors. The mean harvested cell content was 8.74+/-3.22X10(8) MNCs/kg, 15.65+/-16.02X10(6) CD34+ cells/kg of the patients. There were significant differences in the harvested MNC count between mobilization group with GM-CSF alone and group with a bination of GM-CSF and G-CSF. Observed side effects of cytokine mobilization were myalgia (76%), headache (41%), febrile sense (24%) and skin rash (10%). These complications disappeared within 48 hours after discontinuation of cytokines. The median interval to achieve a WBC count>500/uL was 15.00+/-4.23 days, and 14.00+/-33.01 days to a platelet count>20,000/uL. The actual incidence of acute GVHD was 36.4%, 22.7%, and 4.5% for skin, GIT, and liver, respectively. Immunosuppressant responsive chronic GVHD developed in 63.1% (12/19) of assessable patients including 6 cases who had donor lymphocyte infusions. CONCLUSION: In this study, GM-CSF based cytokine mobilization was able to collect sufficient numbers of stem cells and allow rapid engraftment in the allogeneic PBSCT. Mobilization protocol with a combination of GM-CSF and G-CSF seemed to be superior to GM-CSF alone. Acute GVHD in patients with allogeneic PBSCT didn't appear to be more severe than in patients undergoing allogeneic BMT.
