High Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation in Pediatric Patients with High-risk Neuroblastoma / 대한수혈학회지

BACKGROUND: High dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) has become standard therapy for high-risk neuroblastoma patients. We performed a retrospective analysis to assess the characteristics of peripheral blood stem cell harvest (PBSCH) and PBSCT and its clinical outcome. METHODS: We reviewed 17 cases of patients with high-risk neuroblastoma that underwent PBSCH and/or high dose chemotherapy followed by PBSCT. RESULTS: Sixteen patients had stage IV neuroblastoma and one patient had a stage III neuroblastoma with MYCN amplification. The median age of the 17 patients was 43 months (range 22~114 months) and the median body weight was 15 kg (range 10~24 kg). After induction chemotherapy using a modified N7 protocol, 34 PBSCHs (1.5 leukapheresis per PBSCH) were performed. A statistically significant correlation was found between the pre-leukapheresis CD34+ cell count and the total number CD34+ cells of the harvested products (P<0.0001). Tyrosine hydroxylase mRNA was not detected by RT-PCR in all of the leukapheresis products. High dose chemotherapy followed by PBSCT was performed in 24 cases. The mean infused CD34+ cell dose was 4.01x106/kg and WBC and platelet engraftment was performed on day 12.0 and 21.5, respectively. Eleven patients died, and six patients are surviving 11 to 68 months after PBSCT (median survival time, 35 months). CONCLUSION: In this single institution study, treatment with high dose chemotherapy and PBSCT was performed successfully for children with high-risk neuroblastoma.

Usefulness of IMI and HPC of Sysmex SE-9000, and IRF and HFR of Sysmex R-3000 to Refine Apheresis Timing of Peripheral Blood Stem Cell Harvest / 대한혈액학회지

BACKGROUND: The Sysmex SE-9000 and R- 3000 automated cell counters provide estimates of immature cells referred to as immature myeloid information (IMI), hematopoietic progenitor cells (HPC), immature reticulocyte fraction (IRF) as high and medium fluorescent reticulocytes, and high fluorescence ratio (HFR) as high fluorescent reticulocytes. The aim of this study was to evaluate whether these parameters were useful to refine apheresis timing of peripheral blood stem cell (PBSC) harvest. METHOD: For 140 peripheral blood harvest procedures of 26 patients, pre-harvest peripheral blood (PB) WBC, mononuclear cells (MNC), IMI, HPC, CD34-positive cells, reticulocyte (%, number), IRF and HFR were tested and compared with harvested CD34-positive cell content. RESULTS: Correlation coefficients between pre-harvest WBC, MNC, IMI, HPC, CD34-positive cells, reticulocyte %, reticulocyte number, IRF and HFR of PB and harvested CD34-positive cell content were 0.15, 0.06, 0.60, 0.78, 0.77, 0.004, 0.06, 0.28 and 0.40. Applying the criteria IMI 300X10degrees/L, HPC 5X10degrees/L and CD34-positive cells 5X10derees/L of PB on the first day of 30 cycles of harvests, positive predictive value to predict the mean CD34+ cell count over 0.5X106/kg per one leukapheresis and negative predictive value to predict the mean CD34+ cell count less than 0.5X10derees/kg per one leukapheresis were 73.3%/93.3%, 57.8%/90.9% and 78.6%/ 93.7% respectively. CONCLUSION: Pre-harvest PB IMI and HPC of Sysmex SE-9000 are comparable with PB CD34- positive cells in terms of correlation with harvested CD34-positive cell content. For PB IMI and HPC are simple, inexpensive and rapid to get results, PB IMI and HPC are useful to refine apheresis timing of PBSC harvests and to screen poor-mobilizers.

Changes of Electrolytes, Hemoglobin and Platelets before and after Peripheral Blood Stem Cell Collection / 대한임상병리학회지

BACKGROUND: Many studies have reported hypocalcemia during peripheral blood stem cell (PBSC) collection. On the other hand, changes in other electrolyte levels such as potassium have received little attention. To see if it is necessary to monitor other electrolytes, we determined sodium, potassium, chloride, total CO(2), and ionized calcium before and after the PBSC harvest. The changes in hemoglobin and platelets were also investigated. METHODS: A total of 111 PBSC harvest procedures for thirty-six patients or donors were included in this study. The samples were collected within 2 hours around PBSC harvest. Patients who received blood transfusions or in whom electrolytes were administered immediately before or during the procedure were excluded from the evaluation. RESULTS: In the autologous PBSC harvest using CS3000, all five electrolytes showed significant changes. Ionized calcium significantly dropped by about 7.2+/-13.1% at the end of apheresis. Potassium significantly decreased to 12.3+/-10.2% during PBSC harvest. Hemoglobin and platelets significantly decreased except the autologous PBSC harvest using CS3000 and Cobe, respectively. CONCLUSIONS: Our data reveal a strong association between anticoagulant-induced hypocalcemia and concomitant hypokalemia during the PBSC harvest. We suggest that the potassium level should be carefully monitored, especially for patients with relatively low preharvest potassium levels.