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Chinese Journal of Hematology ; (12): 141-145, 2022.
Article in Chinese | WPRIM | ID: wpr-929546


Objective: To evaluate the efficacy and safety of autologous hematopoietic stem cell transplantation (auto-HSCT) in elderly patients (≥65 years old) with multiple myeloma (MM) . Methods: From June 1, 2006 to July 31, 2020, 22 MM patients (≥65 years old) who were diagnosed in the First Affiliated Hospital, Sun Yat-sen University and received novel drug induction followed by auto-HSCT were analyzed retrospectively. These patients were evaluated for important organ functions before transplantation, and the International Myeloma Working Group frail score was used in 2016 to screen out transplant-eligible patients. Results: The median (interquartile range, IQR) age at the time of transplantation of the 22 patients was 66.75 (IQR 4.50) years. A total of 20 patients received stem cell mobilization. The median number of mononuclear cells collected was 4.53×10(8)/kg, that of CD34(+) cells was 3.37×10(6)/kg, and the median number of apheresis procedures performed was 2. After stem cell transfusion, the median time of neutrophil implantation was 11 days, that of platelet implantation was 13 days, and the treatment-related mortality was 0 at 100 days after transplantation. The median follow-up was 48.7 months. The median time to progression time was not reached, and the median overall survival time was 111.8 months. Conclusion: Auto-HSCT is a safe and effective treatment for selected elderly patients of 65 years or older with MM.

Aged , Humans , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cell Transplantation/adverse effects , Multiple Myeloma/drug therapy , Retrospective Studies , Transplantation, Autologous/methods , Treatment Outcome
Rev. Assoc. Med. Bras. (1992) ; 62(supl.1): 10-15, Oct. 2016.
Article in English | LILACS | ID: biblio-829562


SUMMARY Selected patients with certain hematological malignancies and solid tumors have the potential to achieve long-term survival with autologous hematopoietic progenitor cell transplant. The collection of these cells in peripheral blood avoids multiple bone marrow aspirations, results in faster engraftment and allows treatment of patients with infection, fibrosis, or bone marrow hypocellularity. However, for the procedure to be successful, it is essential to mobilize a sufficient number of progenitor cells from the bone marrow into the blood circulation. Therefore, a group of Brazilian experts met in order to develop recommendations for mobilization strategies adapted to the reality of the Brazilian national health system, which could help minimize the risk of failure, reduce toxicity and improve the allocation of financial resources.

RESUMO Pacientes selecionados com certas neoplasias hematológicas e tumores sólidos têm o potencial de alcançar sobrevida de longo prazo com o transplante autólogo de células progenitoras hematopoéticas. A coleta dessas células no sangue periférico evita múltiplas aspirações de medula óssea, resulta em enxertia mais rápida, e permite o tratamento de pacientes com infiltração, fibrose ou hipocelularidade medular. Contudo, para o sucesso desse procedimento, é essencial mobilizar um número suficiente de células progenitoras da medula óssea para a circulação sanguínea. Por isso, um painel de especialistas brasileiros se reuniu com o objetivo de desenvolver recomendações para estratégias de mobilização adaptadas à realidade do sistema de saúde nacional, que pudessem contribuir para minimizar os riscos de falha, reduzir a toxicidade e melhorar a alocação de recursos financeiros.

Humans , Hematopoietic Stem Cell Transplantation/methods , Hematopoietic Stem Cell Mobilization/methods , Consensus , Transplantation, Autologous/methods , Cell Count , Risk Factors , Granulocyte Colony-Stimulating Factor , Antigens, CD34/blood , Heterocyclic Compounds
Saudi Medical Journal. 2010; 31 (6): 634-639
in English | IMEMR | ID: emr-105247


To compare the differences between glycosylated and non-glycosylated granulocyte colony-stimulating factor [G-CSF] on mobilizing cell regeneration of bone marrow stem cells and repairing injured myocardium. In the acute myocardial ischemia model, 40 Sprague-Dawley rats [8 weeks old, weight 200-250 g] were successfully established with isoproteronol [ISO] and randomly and evenly divided into 4 groups: Group G [injected with glycosylated G-CSF], Group N [non-glycosylated G-CSF], Group C [[control] normal saline for 7 days], and Group M [model]. At day 5, all rats were labeled with bromodeoxyuridine [BrdU]. At day 28, the proportion of CD34+ cells, myocardial BrdU immunohistochemical stain, myocardial capillary density, myocardial fibrosis and cardiac function was detected among the 3 groups. The study was carried out at the Central Laboratory, Tongji Hospital of Tongji University, Shanghai, China between 1 July 2009 and 31 July 2009. In Group G, the proportion of CD34+ cells and cardiac function was significantly higher than groups N and C, and BrdU positive cells in myocardium were higher than those other groups. Diaminobenzidine stained positive cells in striated muscle tissue possessed more cardiocyte-like structure, higher myocardial capillary density, and less myocardial fibrosis in group G compared with other 2 groups. Glycosytated G-CSF might possess stronger capability to mobilize cell regeneration of bone marrow stem cells and repair injured myocardium

Male , Animals, Laboratory , Hematopoietic Stem Cell Mobilization/methods , Myocardial Infarction/therapy , Cell Proliferation , Antigens, CD34 , Immunohistochemistry , Bone Marrow Cells , Rats, Sprague-Dawley , Graft Survival
Rev. invest. clín ; 57(2): 305-313, mar.-abr. 2005. graf
Article in Spanish | LILACS | ID: lil-632485


Multiple myeloma (MM) is the second most common hematologic malignancy, affecting approximately 14,000 new patients per year in the United States. For over four decades, the standard treatment for MM has been a regimen of melphalan combined with prednisone. Using this treatment modality, complete responses are rare, and 50% of patients have had disease that was resistant to chemotherapy. Attempts have been made to improve the outcome of MM by administering combinations of I. V. polichemotherapy, but these treatments are equivalent in terms of overall survival. High-dose therapy with peripheral blood stem cell support can be applied safely in these patients and achieves significantly higher complete remission rates as well as better event-free survival and overall survival. However, neither tumor-cell purging, positive selection, intensification of conditioning with additional chemotherapeutic agents, nor total body irradiation have been shown to improve outcome. The role of tandem transplantation with high-dose melphalan seems to be a good selection of treatment in hospitals having all resources. Future research will include the combination of the best remission-induction regimen with tandem transplants and maintenance treatments (thalidomide, idiotype or dendritic cell vaccination) that will sustain complete remission. Development of non-myeloablative allogeneic transplantation in order to exploit the graft-versus myeloma effect provides an alternative for patients who have a compatible donor. Combining all of these modalities with the new drugs developed few years ago (thalidomide, bortezomib, revlimid), we hope that MM will become a manageable chronic disease and perhaps a curable disease at least for 30% to 40% of the patients.

El mieloma múltiple (MM) es la segunda patología oncohematológica más frecuente. En Estados Unidos son diagnosticados anualmente 14,000 casos nuevos. En las últimas cuatro décadas el tratamiento estándar ha sido la combinación de melfalán y prednisona. Con este régimen raramente se logran remisiones completas y 50% de los pacientes no responden a esta terapia. Se han hecho intentos de mejorar los resultados combinando poliquimioterapia, pero la sobrevida global ha sido la misma. Al aplicar quimioterapia a dosis altas y rescate con trasplante de células hematopoyéticas se logra un mayor porcentaje de remisiones completas, asimismo, una mayor sobrevida libre de enfermedad y sobrevida global. La purga de células hematopoyéticas, selección positiva, intensificación del régimen de acondicionamiento con otras drogas o irradiación corporal total, no han demostrado utilidad en términos de sobrevida global. El doble trasplante autólogo de células hematopoyéticas parece ser una opción útil para hospitales que cuentan con la infraestructura y los recursos necesarios para realizarlo. En un futuro, la investigación deberá incluir el uso del mejor régimen de inducción a la remisión más doble trasplante autólogo y terapia de mantenimiento (talidomida o vacunas con células dendríticas), con la finalidad de al menos prolongar la remisión completa. El uso del trasplante alogénico no mieloablativo para provocar el efecto injerto contra mieloma parece una buena alternativa para los pacientes que tengan donador. Al combinar todas estas modalidades de tratamiento con las nuevas drogas desarrolladas en los últimos años (talidomida, bortezomid, revlimid), se espera que en un futuro el MM se convierta en una enfermedad crónica y curable en al menos 30 a 40% de los enfermos.

Humans , Hematopoietic Stem Cell Transplantation , Multiple Myeloma/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Purging , Combined Modality Therapy , Disease-Free Survival , Hematopoietic Stem Cell Mobilization/methods , Hospitals, Public/statistics & numerical data , Life Tables , Lymphocyte Transfusion , Mexico/epidemiology , Multiple Myeloma/drug therapy , Multiple Myeloma/epidemiology , Randomized Controlled Trials as Topic , Remission Induction , Transplantation, Autologous , Transplantation, Homologous , Treatment Outcome , Transplantation Conditioning/methods , United States/epidemiology
Asian Pac J Allergy Immunol ; 2001 Sep; 19(3): 183-90
Article in English | IMSEAR | ID: sea-36985


We studied granulocyte colony-stimulating factor (G-CSF) mediated peripheral blood progenitor cells (PBPC), which were mobilized and collected from healthy donors for allogeneic transplantation. A total of 26 donors, age ranged from 21-41 years were mobilized with G-CSF at a dose of 7.5 microg/kg/day subcutaneously for 5 days and the collection was started on day 5. The CD34 cell counts reached a maximum on day 5 and subsequently declined despite continually given G-CSF. White blood cells (WBC), absolute neutrophil counts (ANC), absolute lymphocytes (AL) and their subsets, absolute mononuclear cells (AMNC), colony-forming unit-granulocyte, macrophage (CFU-GM) and CD34+ cells were increased about 6, 9, 2, 3, 34 and 40-fold, respectively, but red blood cells (RBC), hematocrit (Hct) and platelets (Pit) decreased on day 5 when compared to day 0. All parameters decreased after stem cell collection. For stem cell collection by Cobe Spectra, we used a blood volume of 19.27 +/- 4.65 liters, flow rate of 60.53 +/- 10.03 ml/minute, acid citrate dextrose solution (ACD)/blood ratio of 1:13.31, the final product volume was 314.14 +/- 72.24 ml, collection time was 325.40 +/- 73.36 minutes and one or two procedures were sufficient. The correlation between the number of CD34+ cells/kg, CFU-GM/kg and MNC/kg found in the harvested product and CD34 cells can be used for determining the necessary amount of progenitor cells for transplantation.

Adult , Antigens, CD34/blood , Blood Cell Count , Colony-Forming Units Assay , Female , Filgrastim/pharmacology , Granulocyte Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells/cytology , Humans , Leukapheresis , Leukocytes, Mononuclear/cytology , Male , Recombinant Proteins/pharmacology , Transplantation, Homologous
Article in English | WPRIM | ID: wpr-43385


The purpose of this study was to develop a cost-effective protocol for the mobilization of peripheral blood stem cells (PBSC) in patients with malignancy. Thirty consecutive patients were randomized to mobilize PBSC with the late addition of a standard 250 microg dose of G-CSF (Neutrogen) from day 8 or early addition of the same dose of G-CSF from day 2, following cyclophosphamide (CY) 4 g/m2. The median yield of CD34+ cells from evaluated patients was 7.87 x 10(6)/kg (range, 2.06-27.25), collected in a median of four apheresis (range, 2-9). Target CD34 + cell doses > or = 2.0 x 10(6)/kg were achieved in all patients able to be evaluated. There were no statistically significant differences in CD34+ cell yields or toxicities. Overall engraftment occurred with median days to neutrophils > or = 0.5 x 10(9)/L or platelets > 20 x 10(9)/L of 11 and 17 days, respectively. However, the duration of G-CSF administration was markedly shorter in the late use of G-CSF group than in the early use of G-CSF group, with a median of 9 days compared with 15 days (p>0.001). PBSC harvesting after priming with CY plus delayed use of G-CSF made it a safe and cost-effective procedure.

Adult , Aged , Female , Humans , Male , Antigens, CD34/metabolism , Antigens, CD34/immunology , Antineoplastic Agents, Alkylating/therapeutic use , Antineoplastic Agents, Alkylating/adverse effects , Breast Neoplasms/therapy , Comparative Study , Cost-Benefit Analysis , Cyclophosphamide/therapeutic use , Cyclophosphamide/adverse effects , Drug Administration Schedule , Graft Survival , Granulocyte Colony-Stimulating Factor/therapeutic use , Granulocyte Colony-Stimulating Factor/adverse effects , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cell Mobilization/economics , Hematopoietic Stem Cell Mobilization/adverse effects , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells/metabolism , Hematopoietic Stem Cells/immunology , Lymphoma, Non-Hodgkin/therapy , Middle Aged , Multiple Myeloma/therapy , Sarcoma, Ewing/therapy