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Transfus Apher Sci ; 60(5): 103197, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1275746


High-dose chemotherapy followed by autologous stem cell transplantation is a major component in the treatment of patients with multiple myeloma. As a prerequisite, the successful collection of a sufficient number of viable peripheral blood hematopoietic CD34+ cells is critical. A common standard protocol for mobilization is currently not defined and critically discussed especially in German-speaking Europe. In times of the Covid-19 pandemic, safe and effective strategies have to be chosen to minimize hospitalization times and severe courses. In this single-center retrospective analysis, safety and efficacy of cyclophosphamide plus etoposide (CE) and growth-factor support (n = 33) was compared to cyclophosphamide mono treatment and growth-factor support (n = 49) in 82 patients with multiple myeloma at first diagnosis. CE was superior to cyclophosphamide mono with a significantly higher number of collected CD34+ cells (15.46 × 106 CD34+ cells/kg vs. 9.92 × 106 CD34+ cells/kg), significantly faster engraftment of granulocytes after stem cell transplantation (day 10.5 vs. day 11.6), shorter duration of the inpatient stay (17.47 days vs. 19.16 days) and significantly less transfusions (8.82 % vs. 30.61 % patients receiving transfusions). The safety profile was comparable in both groups and in line with published data. We conclude that CE is a safe and highly effective mobilization protocol in patients with multiple myeloma at first diagnosis and appears to be superior to the commonly used cyclophosphamide mono regimen.

Antineoplastic Combined Chemotherapy Protocols/pharmacology , Cyclophosphamide/pharmacology , Etoposide/pharmacology , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cells/drug effects , Multiple Myeloma/therapy , Peripheral Blood Stem Cell Transplantation/methods , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19 , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Female , Granulocyte Colony-Stimulating Factor/pharmacology , Humans , Male , Melphalan/administration & dosage , Middle Aged , Multiple Myeloma/blood , Myeloma Proteins/analysis , Pandemics , Retrospective Studies , SARS-CoV-2 , Transplantation, Autologous
Biol Blood Marrow Transplant ; 26(7): e161-e166, 2020 07.
Article in English | MEDLINE | ID: covidwho-799190


With the COVID-19 pandemic and the ensuing barriers to the collection and transport of donor cells, it is often necessary to collect and cryopreserve grafts before initiation of transplantation conditioning. The effect on transplantation outcomes in nonmalignant disease is unknown. This analysis examined the effect of cryopreservation of related and unrelated donor grafts for transplantation for severe aplastic anemia in the United States during 2013 to 2019. Included are 52 recipients of cryopreserved grafts who were matched for age, donor type, and graft type to 194 recipients who received noncryopreserved grafts. Marginal Cox regression models were built to study the effect of cryopreservation and other risk factors associated with outcomes. We recorded higher 1-year rates of graft failure (hazard ratio [HR], 2.26; 95% confidence interval, 1.17 to 4.35; P = .01) and of 1-year overall mortality (HR, 3.13; 95% CI, 1.60 to 6.11; P = .0008) after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% (95% CI, 60% to 84%) in the cryopreserved graft group and 91% (95% CI, 86% to 94%) in the noncryopreserved graft group. These data support the use of noncryopreserved grafts whenever possible in patients with severe aplastic anemia.

Anemia, Aplastic/therapy , Bone Marrow Transplantation/methods , Coronavirus Infections/epidemiology , Cryopreservation/methods , Graft Rejection/pathology , Graft vs Host Disease/pathology , Peripheral Blood Stem Cell Transplantation/methods , Pneumonia, Viral/epidemiology , Acute Disease , Adolescent , Adult , Aged , Anemia, Aplastic/immunology , Anemia, Aplastic/mortality , Anemia, Aplastic/pathology , COVID-19 , Child , Child, Preschool , Female , Graft Rejection/immunology , Graft Rejection/mortality , Graft vs Host Disease/immunology , Graft vs Host Disease/mortality , Histocompatibility Testing , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Siblings , Survival Analysis , Transplantation Conditioning/methods , United States/epidemiology , Unrelated Donors
Transfusion ; 60(9): 1905-1909, 2020 09.
Article in English | MEDLINE | ID: covidwho-613577


New York is at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus. Columbia University Irving Medical Center/NewYork-Presbyterian Hospital (CUIMC/NYPH) had to make changes to its cellular therapy operations to ensure patient, donor, and staff safety and well-being. In this article, we discuss the process changes we instituted for cellular therapy clinical care, collection, processing, and cryopreservation to cope with the rapidly evolving pandemic.

Academic Medical Centers , COVID-19/epidemiology , Cell- and Tissue-Based Therapy/statistics & numerical data , Pandemics , SARS-CoV-2 , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , Bone Marrow Transplantation/methods , Bone Marrow Transplantation/statistics & numerical data , COVID-19 Testing , Cell Separation/methods , Child , Clinical Trials as Topic/organization & administration , Cryopreservation/methods , Donor Selection , Humans , Immunotherapy, Adoptive/methods , Immunotherapy, Adoptive/statistics & numerical data , Lymphocyte Transfusion/methods , Lymphocyte Transfusion/statistics & numerical data , New York City/epidemiology , Organ Preservation/methods , Peripheral Blood Stem Cell Transplantation/methods , Peripheral Blood Stem Cell Transplantation/statistics & numerical data , Preservation, Biological/methods , Procedures and Techniques Utilization , Tissue Donors , Tissue and Organ Procurement/methods , Tissue and Organ Procurement/organization & administration