RESUMO
Data of 507 granulocyte donations from 183 donors were evaluated. No severe granulocyte colony-stimulating factor (G-CSF)-related side-effects were observed. Three donors complained of severe itching following infusion of hydroxyethyl starch (HES). A high proportion (85%) of the donors stated that they would donate granulocytes again. The mean granulocyte yield was 4.3 x 10(10). High-molecular-weight HES resulted in a significantly higher yield compared with low-molecular-weight HES. Mild, but no severe, adverse transfusion reactions were observed in 16% of the recipients. A leucocyte alloimmunization rate of 24% was found. G-CSF stimulation and transfusion of G-CSF-mobilized granulocytes were well tolerated by donors and recipients, respectively.
Assuntos
Doadores de Sangue , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Granulócitos , Contagem de Leucócitos , Transfusão de Leucócitos/efeitos adversos , Adolescente , Adulto , Idoso , Arritmias Cardíacas/induzido quimicamente , Testes Imunológicos de Citotoxicidade , Tontura/induzido quimicamente , Toxidermias/etiologia , Fadiga/induzido quimicamente , Feminino , Febre/etiologia , Filgrastim , Fator Estimulador de Colônias de Granulócitos/farmacologia , Granulócitos/imunologia , Humanos , Leucaférese , Masculino , Pessoa de Meia-Idade , Dor/induzido quimicamente , Proteínas RecombinantesRESUMO
A pediatric patient with very early meningeal relapse of his CD34(+) CD133(-) pre-B-ALL was transplanted with 2.5 x 10(6)/kg CD133 selected autologous progenitor cells. Enrichment of CD133(+) cells resulted in a purity of 92.3 +/- 3.5% CD133(+). Hematopoietic engraftment with >1.0 x 10(9)/l neutrophils and >50 x 10(9)/l platelets was reached within 13 and 24 days, respectively. At a follow-up of 11(1/2) months after autologous transplantation, the patient is in complete remission. To our knowledge, the successful transplantation with a CD133 selected graft is the first one to be reported worldwide. CD133 selected cells may serve as an alternative in the case of CD34(+) malignancy.
Assuntos
Glicoproteínas , Transplante de Células-Tronco Hematopoéticas/métodos , Peptídeos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Antígeno AC133 , Doença Aguda , Antígenos CD , Criança , Sobrevivência de Enxerto , Humanos , Leucaférese/métodos , Masculino , Indução de Remissão , Terapia de Salvação , Transplante Autólogo/métodosRESUMO
Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.