ABSTRACT
The use of therapeutic apheresis in very low weight patients is generally thought to have limitations, because of possible severe adverse reactions, potential risk related to the extracorporeal procedure, due to the low weight of the young patients. A careful therapeutic approach using appropriate precautions, and also introducing modifications to the standard procedure, can minimise the risk without compromising the efficacy of the plasmapheresis. The aim of the study was to evaluate apheresis tolerance and acceptability in children [Artif. Organs. 21 (1997) 1126] and infants [J. Clin. Apheresis 5 (1989) 21] with inherited lipid metabolism disorder, familial hypercholesterolemia (FH), primary hyperlipoproteinemia (lipoprotein phenotype I), and acute leukemia, weighing on average 20.55 kg. One thousand one hundred twenty three aphereses were completed. Three types of apheresis were performed: leukapheresis, plasma exchange, dextran sulphate cellulose (DSC) low density lipoprotein (LDL)-apheresis. Three different types of continuous flow systems were used. Technical adaptation depending on patients blood volume, body mass index, hematocrit, type of system used, permitted us to perform complete aphereses, obtaining a high degree of tolerance and acceptability of the treatment. The use of plasmapheresis is regarded to be an extreme therapeutic measure in children. However, when the need for such treatment is undebatable, plasmapheresis must be done. A well-trained and experienced team can overcome the technical difficulties in order to complete the procedures without complications. The most frequently observed adverse effects are vascular relative access insufficiency (2.0%), and mild hypotension (2.0%).
Subject(s)
Blood Component Removal/methods , Developmental Disabilities/therapy , Thinness/therapy , Adolescent , Blood Component Removal/adverse effects , Body Weight , Child , Child, Preschool , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Male , Patient Compliance , Weight Gain/physiologyABSTRACT
Simultaneous comparative assessment of tumor contamination in bone marrow aspirates and peripheral blood stem cell collections using immunocytochemical techniques was done in 6 children with neuroectodermal tumors. In 3 neuroblastoma patients tumor cells were detected in 5 of 16 marrow samples but not in peripheral blood stem cells. Clonogenic tumor cell reinfusion in the autologous support setting may be avoided in neuroblastoma patients by using peripheral blood stem cells.
Subject(s)
Blood Specimen Collection , Bone Marrow/pathology , Cerebellar Neoplasms/pathology , Hematopoietic Stem Cells/pathology , Medulloblastoma/pathology , Neuroblastoma/pathology , Adolescent , Cerebellar Neoplasms/blood , Child , Child, Preschool , Humans , Medulloblastoma/blood , Neoplasm Invasiveness , Neuroblastoma/bloodABSTRACT
A method for collecting peripheral blood mononuclear cells following mobilizing chemotherapy in pediatric patients is described. The critical elements of the method included temporary heparinization of the patient to reduce citrate overload, and limiting extracorporeal circulation to 15% of the patient's blood volume using packed red blood cells and albumin. A median of 0.9 x 10(8) mononuclear cells/kg per collection were harvested in 40 collections from eight patients with only one episode of fever and chills. Peripheral blood stem cells were reinfused into six of these patients with refractory/recurrent pediatric tumors after intensive chemotherapy. Bone marrow reconstitution followed with a mean of 30 days (19-38) for absolute neutrophils and 48 days (32-275+) for platelets. Previous chemotherapy did not appear to affect peripheral blood stem cell efficacy in reconstituting chemotherapy-ablated bone marrow.
Subject(s)
Blood Specimen Collection/methods , Bone Marrow/pathology , Hematopoietic Stem Cell Transplantation , Leukopenia/therapy , Adolescent , Child , Child, Preschool , Feasibility Studies , Humans , Leukopenia/chemically induced , Neutropenia/chemically induced , Neutropenia/therapy , Salvage Therapy/methodsABSTRACT
In view of the high relapse rate following chemotherapy for patients with advanced neuroblastoma (NB) and primitive neuroectodermal tumors (PNET), we designed a novel chemotherapy program which incorporated the iron chelator deferoxamine. The purpose of the deferoxamine was to sensitize the cells to standard chemotherapy. The D-CECaT regimen contained (in mg/m2): deferoxamine 4500 during days 1-5; cyclophosphamide 600 mg over days 6 and 7; etoposide 300 mg over days 7 and 8; carboplatin 100 mg over days 7 and 8; and thiotepa 30 mg over days 6-8. Between October 1989 and May 1992 we entered 23 advanced NB and two PNET patients. Sepsis occurred in four courses, nausea and vomiting in 30 courses, and 50 courses required blood and platelets. Responses observed in previously untreated patients with stage III NB: six out of six CR (17+ to 41+ months), with stage IV NB, nine out of 11 CR (14+ to 28+ months), two out of 11 VGPR (22+ months), with stage IV PNET two out of two CR (1+ to 35+ months). With previously treated and failed stage IV NG, two out of six VGPR for 19+ and 20 months, and four out of six PR 1, 8, 9 and 11 months. Median survival for 19 new patients was 22+ months (6 to 41+ months; two patients in CR died at 7 months during adjuvant autologous marrow transplant). In conclusion, D-CECaT is an effective initial cytoreductive regimen for advanced stage NB/PNET patients. Additional patients and studies are required to determine its use as an alternative to autologous bone marrow transplantation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasms, Germ Cell and Embryonal/drug therapy , Neuroblastoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Blood Cell Count/drug effects , Carboplatin/administration & dosage , Carboplatin/adverse effects , Child , Child, Preschool , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Deferoxamine/administration & dosage , Deferoxamine/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Humans , Infant , Neoplasms, Germ Cell and Embryonal/blood , Neuroblastoma/blood , Thiotepa/administration & dosage , Thiotepa/adverse effectsABSTRACT
Peripheral Blood Stem Cell collection in adults is a consolidated method for autografting. The same procedure is less easily performed in pediatric patients due to low weight, vascular access problems and anticoagulant side effects. Great efforts have been made to overcome technical difficulties and make apheresis in children a reliable and safe procedure.
Subject(s)
Catheterization, Central Venous/instrumentation , Citric Acid , Hematopoietic Stem Cells , Leukapheresis/methods , Adolescent , Blood Volume , Body Weight , Child , Child, Preschool , Female , Glucose/administration & dosage , Glucose/adverse effects , Glucose/analogs & derivatives , Hematopoietic Stem Cell Transplantation , Heparin/administration & dosage , Humans , Leukapheresis/instrumentation , Male , Neoplasms/blood , Neoplasms/therapy , Transplantation, AutologousABSTRACT
The plasma-exchange has been recently adopted in the therapy of the hemolytic-uremic syndrome. We experimented this therapy, without any complication with traditional treatment (anti platelet-aggregation, frozen fresh plasma), on a child of 6 years and 8 months old. A rapid normalization of the clinical syntomatology was obtained without sequences also after a long period. The PE therapy has to be carefully valued on the solution of the SUE in order to establish the cases to be treated, missing proved results from controlled experiments.
