Gemtuzumab Ozogamicin Combined With Intensive Chemotherapy in Patients With Acute Myeloid Leukemia Relapsing After Allogenic Stem Cell Transplantation.

BACKGROUND: More than one-third of patients with acute myeloid leukemia (AML) will relapse after allogenic hematopoietic cell transplant (allo-HCT). The main challenge is to overcome disease resistance to achieve a new complete remission while avoiding excessive toxicity. Gemtuzumab ozogamicin (GO), a conjugate of calicheamicin linked to the humanized monoclonal anti-CD33 antibody, has been used for refractory or relapsed AML with promising response rates, but liver toxicity of GO has long been considered a limiting factor. PATIENTS AND METHODS: We included 18 consecutive patients with AML relapsing after a first allo-HCT and treated with fractioned GO (fGO) and intensive chemotherapy. The median age was 40 years (range, 18-65). RESULTS: The overall response rate was 72% (13/18), including 7 complete remissions. No death was attributed to treatment toxicity. The main liver toxicity was transient and consisted of transaminase level elevation and hyperbilirubinemia. No cases of veno-occlusive disease were observed after the GO treatment. From the time of salvage treatment initiation, 1- and 2-year OS rates were 54% (95% confidence interval, 28%-74%) and 42% (95% confidence interval, 19%-63%), respectively. CONCLUSIONS: Our study suggests the feasibility, efficacy, and safety of an fGO-based salvage regimen combined with intensive chemotherapy in patients with CD33+ AML in the case of early relapse after an allo-HCT.

The organization of the autotransfusion-perioperative blood salvage at San Martino Hospital.

Autologous transfusion is playing an important role in modern transfusion medicine. At San Martino hospital we use a combination of manual and mechanical techniques in order to improve autotransfusion procedures, control the hypertransfusion and avoid waste. Our autotransfusion program has determined a 55% reduction in the red cell concentrates used (from 42,000 in 1985 down to 19,400 in 1992). Proper training, cultural improvements and new applications on autotransfusion procedures will permit a better use of blood with less transfusion related complications, until a suitable substitute for blood will be available.

Plateletpheresis with the new Fresenius AS 104 blood cell separator.

Among the many blood cell separators introduced into the international market in these last few years, the Fresenius AS 104 represents an advanced and safe thrombocytapheresis machine whose development took advantage of extensive worldwide experience with blood cell separation. Nonetheless the AS 104 has generated most interest in West Germany and most, if not all, the studies published on its platelet collection efficiency have been carried out in that country. It is normally reported that from 2.7 to 3.5 x 10(11) platelets can be collected in approximately 80 minutes. Since these results could not be duplicated routinely in our hemapheresis unit, we set up a study by modifying the standard procedure. It was possible to reduce the procedure time and to collect platelet concentrates containing more than 4 x 10(11) cells on a routine basis by using the following procedure: ACD-A/blood ratio 1:10; Interface position 6:2; blood flow rate always exceeding 65 mL/min; rpm 1750; cell collection from 4 to 7 mL/min; volume of blood processed 3.6 L followed by the rinsing of the system with 200 ml of saline; extraction of the content of the secondary separation chamber by the action of the plasma pump working at 20 mL/min for 2 min. With this procedure the platelet yield in 34 collections exceeded 3.1 x 10(11) and averaged 4.06 x 10(11). The procedure time was reduced to 56.5 minutes with a mean blood flow rate of 62.3 mL/min. The leukocyte and erythrocyte contamination of the products were in the range of 1 x 10(7) and 1 x 10(8) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Autotransfusion protocol for patients undergoing elective orthopedic surgery]. / Protocollo autotrasfusionale per pazienti sottoposti ad interventi di chirurgia ortopedica elettiva.

After reviewing the advantages of self-transfusional techniques, experience with 136 patients undergoing elective surgery is reported. In all cases treated, transfusional support was completely autologous, with a readily understandable saving in bank blood. Cases examined also show that sel-transfusional techniques represent an effective precautionary measure against thromboembolic complications and blood-related pathologies.

Plasma exchange for the management of cyclosporin A-induced hypertriglyceridemia.

The authors report a case of hypertriglyceridemia complicating the course of a patient receiving cyclosporin A after bone marrow transplantation. When the patient was seen at the hemapheresis unit the clinical picture was characterized by headache, increasing visual and neurological disturbances. Plasma triglyceride level was 3215 mg/dl. Two plasma exchange sessions reduced triglycerides to 486 mg/dl and halted the disease progression. This may represent the first plasma exchange treatment of cyclosporin A-induced hypertriglyceridemia.

Thrombotic microangiopathy of the miscellaneous secondary type responding to plasma exchange in a liver transplant recipient.

A thrombotic microangiopathy syndrome, clinically and pathologically similar to thrombotic thrombocytopenic purpura (TTP) has been reported in recipients of tissue transplants, including renal and bone marrow allografts. The diagnosis is made only after other causes of microangiopathic hemolytic anemia have been excluded. In this case report we present the outcome of the combination of plasma exchange, dipyridamole and aspirin in the management of a TTP-like syndrome that complicated the post-operative course of liver transplantation.

Plateletpheresis concentrates produced in 30 minutes along with plasma and packed red cells: preliminary results.

Centrifugal devices for donor plasmapheresis that collect platelets as a by-product have recently been introduced. The platelet yield ranges from 1.2 to 2 X 10(11) per collection, and the collection time exceeds 50 minutes. An attempt to increase yields and to reduce the procedure time was carried out at our center, taking advantage of the Dideco Eccentriplate (Dideco spa, Mirandola, Italy). Within 30 minutes, 510 ml of plasma were collected along with 3.3 X 10(11) platelets. The shift of donors from whole blood to plasma and platelet donation generated a progressive decrease in red-cell availability. In order to maintain plasma and platelet production without affecting the erythrocyte production, a technique was developed that allows the collection of 3.68 X 10(11) platelets, 250 ml of plasma, and 225 ml of packed red blood cells with a hematocrit of 66.5%. The mean procedure time was 31.6 minutes; 2,671 ml of blood were processed at flow rates of 85-100 ml/minute. The cellular cross contamination of the platelet concentrates was 1.76 X 10(8) (leukocytes) and 2.23 X 10(8) (erythrocytes). Although the procedure was carried out in a selected group of donors, the technical experience has strongly modified our procedure for platelet and plasma collection.

New application of the autotrans: autologous support of the organ donor and salvage of the donor's red blood cells for the transfusion support of organ recipients.

Organ donation is usually limited to solid tissues; paradoxically, organ donors undergoing explant are often transfused in preparation for or during surgery. This practice increases the requirement for blood and adds immunological and infectious risks for both recipients and donors of grafts. We have investigated the possibility of supporting an explant with intraoperative blood salvage and, in the case of a cadaver donor, at the end of the operation, salvaging blood for potential use in the graft recipient. This preliminary report describes the technique and the results obtained in two procedures. The volume of red cells with a hematocrit of 55% obtained from the two donors was 2,090 and 1,180 ml, respectively. These components were employed for the transfusion support of the organ recipients.

Preparation of small volume, leuko and erythrocyte very poor platelet concentrates.

Recently developed automated discontinuous flow centrifuge (DFC) separators can produce leuko- and erythrocyte-poor platelet concentrates (PC). According to general experience with these machines it is difficult to obtain more than 4 X 10(11) platelets, though a second program set up by Coffe et al. appears to produce PC containing approximately 5 X 10(11) platelets suspended in a plasma volume of 390 ml. At our center we employed a new Dideco cell separator equipped with the surge pump and a technique developed for the production of small volume, RBC and WBC-very poor PC. In 60 routine procedures we obtained the following results: mean processing time 87 +/- 11 minutes; final volume of PC 136 +/- 19 ml, with a mean platelet yield of 5.21 X 10(11) platelets. WBC contamination was 1.8 X 10(8) (93% lymphocytes) and RBC were 3.1 X 10(8). Plasma volume as well as WBC and RBC contamination were reduced by recirculating PC after the 6th pass. The demand for single donor platelet concentrates (PC) is increasing progressively. Recently developed automated cell separators can produce leukocyte (WBC) and erythrocyte (RBC) poor PC. With these machines it may be difficult to obtain PC containing at least 4 X 10(11) platelets and less than 1 X 10(9) leukocytes (1, 2, 3) since donor variables such as hematocrit, precounts, buffy coat formation and initial plasma light transmission are of paramount importance for the efficiency of the program. At our center a prototype discontinuous flow centrifuge (DFC) cell separator equipped with the surge pump was studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary colony-stimulating factor in acute leukemia follow-up and correlation with various phases of the disease.

Urinary colony-stimulating factor (CSF) was assayed in 19 patients with various leukemias and was monitored in various phases of acute leukemia in 3 patients. Significantly higher CSF levels were found at the onset of leukemia with a monoblastic component. Continuous monitoring of CSF in a patient with acute myelomonocytic leukemia revealed a decrease in CSF level during the remission phase, followed by a rebound to high levels preceding the clinical and hematological relapse. Concomitantly, a colony-inhibitory factor (CIF) was detected. Both CSF and CIF of this patient were isolated and partially characterized.