Administration of G-CSF can be delayed after transplantation of autologous G-CSF-primed blood stem cells: a randomized study.

Hematopoietic growth factors like G-CSF or GM-CSF have been shown to shorten the period of severe neutropenia after HD chemotherapy and autologous BMT, and are now widely used to mobilize hemopoietic stem cells into peripheral blood. In order to evaluate the possibility of delaying G-CSF administration after transplantation of G-CSF mobilized blood stem cells (BSC), we randomized 35 cancer patients to receive CSF at day 1 (group 1, n = 19) or at day 6 (group 2, n = 16) after transplantation and here we present their hematological reconstitution. BSC collection was performed by apheresis after G-CSF priming for 5 or 6 days (600 micrograms daily subcutaneously). Hematological recovery is comparable between the two groups: a median of 10 (range 7-16) vs 11 (range 9-18) days to reach an ANC > 0.5 x 10(9)/1 in group 1 (G-CSF day 1 after transplant) vs group 2 (G-CSF day 6 after transplant, P = NS). Median time to reach an unsupported platelet count of 25 x 10(9)/1 was 14 days in the two groups (range 8-110 and 10-40 respectively, P = NS); patients received less G-CSF after transplantation in group 2. No difference appeared in terms of transfusion support, number of days of fever of i.v. antibiotic treatment. Patients' hospital stay was the same in the two groups. Our data suggest that delaying G-CSF administration after infusion of mobilized blood cells is not detrimental to hematological recovery, while it lowers the overall cost of the procedure.

Comparison of G-CSF-primed peripheral blood progenitor cells and bone marrow auto transplantation: clinical assessment and cost-effectiveness.

The introduction of hematopoietic growth factors (HGFs) offers new opportunities for autologous transplantation by facilitating and enriching collection of circulating progenitor cells from peripheral blood as a source of stem cell rescue. Substitution of peripheral blood progenitor cells (PBPC) from bone marrow in autologous transplantation for therapy in advanced cancers requires clinical and economic assessment. We carried out the first clinical and cost-effectiveness study in an experimental group of 16 patients autografted with PBPC primed by G-CSF alone and with G-CSF stimulation post-transplantation, comparing these with two other groups of 17 and 21 patients who received autologous bone marrow transplantation with and without G-CSF stimulation, respectively, post-transplantation. We confirmed the ability of primed PBPC to achieve durable engraftment in a shorter time than classical BMT (median number of days to reach 0.5 x 10(9)/l neutrophils = 10.5 versus 12 and 16, respectively) to improve overall hematological recovery (median number of days to recover a platelet count > or = 25 x 10(9)/l, independent of platelet transfusion = 14.5 vs 23 and 20) and to shorten length of hospitalization. Total costs of PBPC autografting remain lower than those of autologous BMT either with or without G-CSF, and cost-effectiveness ratios using hematological recovery end points are in favour of PBPC. Finally, PBPC is a safe and effective way of performing dose-intensification in cancer patients, although further improvements are required to optimize the procedure and so further decrease the costs.

Genotypic analysis in large cell lymphomas expressing a restricted set of differentiation antigens.

Immunophenotyping and immunogenotyping were performed in a series of 8 large cell lymphomas exhibiting anaplastic or "histiocytic" morphology and displaying an uncertain phenotype due to a restricted number of differentiation antigens. 6 cases expressed the Ki-1 antigen. 4 cases expressed one or two B-cell markers and contained rearrangements of the immunoglobulin genes. One of them also exhibited a T-cell receptor (TCR) beta gene rearrangement. 3 cases expressed a single T-cell differentiation antigen. Among them, only 1 displayed both gamma and beta TCR gene rearrangement; 1 only contained a gamma TCR gene rearrangement and 1 completely lacked clonal rearrangements. The eight cases expressed an inconclusive immunophenotype due to an abundant population of reactive cells but showed an immunoglobulin gene rearrangement. In conclusion, 5 out of the 8 unusual lymphomas studied here could be characterized by immunogenotyping. This approach was, however, inconclusive in the 3 remaining cases, whose lineage and differentiation stage remain poorly defined.