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1.
Bone Marrow Transplant ; 53(9): 1116-1123, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523889

RESUMO

Bortezomib-based induction is often used in transplant-eligible patients with myeloma. The optimal peripheral blood stem cell (PBSC) mobilisation strategy in this context is unclear. We reviewed the efficacy of G-CSF alone (G-alone) vs. G-CSF and cyclophosphamide (G-cyclo: standard dose: 1.5-2 g/m2; high dose: 3-4 g/m2) PBSC mobilisation strategies in 288 patients who only received bortezomib, cyclophosphamide and dexamethasone (VCD) induction prior to autograft across six apheresis centres from November 2012 to June 2017. 'Uncomplicated successful mobilisation' was defined as achieving a PBSC yield of ≥4 × 106/kg within two aphereses, without plerixafor or mobilisation-associated toxicity (predominantly febrile neutropenia, FN). Success rates were 84% in G-cyclo standard dose (6% FN), 64% in G-cyclo high dose (18% FN) and 69% in G-alone (plerixafor successfully salvaged 8/9 patients). Median total stem cell yield was significantly higher with G-cyclo, but not different between the two cyclophosphamide doses. Age greater than the median of 61 years was associated with higher failure rates (22 vs. 11%, p = 0.01) and lower PBSC yield, especially in the G-alone group. Prior radiotherapy exposure did not impact on collection success. Our observations suggest that both G-cyclo standard dose and G-alone are reasonable mobilisation strategies. The former may be preferred if salvage plerixafor is unavailable.


Assuntos
Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Mobilização de Células-Tronco Hematopoéticas/métodos , Mieloma Múltiplo/terapia , Células-Tronco de Sangue Periférico/efeitos dos fármacos , Adulto , Fatores Etários , Idoso , Bortezomib/uso terapêutico , Ciclofosfamida/administração & dosagem , Dexametasona/uso terapêutico , Mobilização de Células-Tronco Hematopoéticas/normas , Humanos , Masculino , Pessoa de Meia-Idade , Células-Tronco de Sangue Periférico/citologia , Indução de Remissão/métodos
2.
Br J Haematol ; 149(5): 768-74, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20346014

RESUMO

Thirteen adult patients aged 22-63 (median 30) years with sickle cell disease (SCD) were enrolled in a regular erythrocytapheresis (ECP) programme at a single institution between December 1998 and November 2008. The indications for enrolment were recurrent painful crises (PC), acute chest syndrome (ACS), silent cortical ischaemia, pulmonary hypertension, multi-organ crises and pregnancy. Endpoints retrospectively evaluated included the incidence of SCD-related acute events requiring hospitalization following and prior to regular ECP, the development of new and progression of pre-existing related end-organ damage, the effectiveness in reducing HbS levels acutely and prior to the next exchange and the transfusion-related complications. Sixteen acute sickle-related events occurred in five patients in 846 months of patient follow-up. In all patients with reliable data available pre-ECP, the frequency of such events was reduced following commencing regular ECP. No patient experienced stroke, multi-organ crises or developed new and/or progression of end-organ dysfunction. Regular ECP reduced HbS levels to the target of <30% immediately post-exchange. Alloimmunization rates were comparable to the literature and ECP was effective in preventing progressive iron overload. Regular ECP was demonstrated to be an effective, well-tolerated therapy for both acute and chronic complications of SCD in adults.


Assuntos
Anemia Falciforme/terapia , Citaferese/métodos , Transfusão de Eritrócitos/métodos , Doença Aguda , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/economia , Doença Crônica , Citaferese/economia , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/prevenção & controle , Estudos Retrospectivos , Adulto Jovem
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