An algorithm based on peripheral CD34+ cells and hemoglobin concentration provides a better optimization of apheresis than the application of a fixed CD34 threshold.

BACKGROUND: Optimization of peripheral blood stem cell (PBSC) collection for autologous bone marrow transplantation is necessary for a good standard of care and cost-effectiveness. An algorithm was validated for prediction of the day of maximum peripheral CD34+ cell concentration after mobilization chemotherapy (Day(CD34peak)). STUDY DESIGN AND METHODS: This study compared mobilization and collection variables of a cohort of patients where apheresis was started at the Day(CD34peak) predicted by the algorithm with a patient group where PBSCs were collected when PB CD34+ cell concentration reached 10 per microL per day (Day(CD34threshold)). Day(CD34peak) was calculated according to the equation Day(CD34peak) = -0.41 x Hb(D0) + 0.99 x Day(CD34threshold) + 7.8 (with Hb(D0) representing the hemoglobin value on Day 0). RESULTS: The mean number of apheresis procedures per patient based on the Day(CD34threshold) was 1.74, but decreased to 1.35 when applying the new method (Day(CD34peak)). For lymphomas, the mean number of apheresis procedures decreased from 1.98 to 1.47 (p = 0.03), while in patients with multiple myeloma it did not change significantly (1.23 and 1.26, respectively). Age and primary disease influenced the number of apheresis procedures needed to achieve the collection target. CONCLUSION: The application of our algorithm can lower the number of apheresis procedures by improving the timing, especially in patients suffering from malignant lymphomas with a poor marrow potential after several chemotherapy lines.

Guillain-Barré syndrome in the elderly: clinical, electrophysiological, therapeutic and outcome features.

UNLABELLED: There are few papers devoted to geriatric Guillain-Barré (GBS) and many related issues remain unanswered. OBJECTIVE: To describe clinical, electrophysiological and therapeutic features in this age. METHOD: Clinico-epidemiological data and therapy of GBS patients older than 60 years were reviewed. Hughes scores were used to quantify neurological deficit and define outcome. RESULTS: Among 18 patients (mean age 64.8 years), 9 had evident prodrome and 80% noticed initially sensory-motor deficit. Demyelinating GBS was found in 8 and axonal in 6 subjects. There was one Miller-Fisher and 3 unclassified cases. Plasmapheresis (PFX) was single therapy in 12 patients and intravenous immunoglobulin (IVIg) in 2. Disability scores just before therapy were similar in both groups, so as short and long term outcome. CONCLUSION: Axonal GBS seems to be more frequent in the elderly and this may have prognostic implications. PFX and IVIg were suitable options, but complications were noticed with PFX. Prospective studies are needed to better understand and manage GBS in the elderly.

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients.

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD +/- 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD +/- 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD +/- 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

Transplante alogênico de céluls progenitoras hemopoéticas periféricas / Allogeneic peripheral blood progenitors cells transplatation

As células progenitoras periféricas têm sido uma alternativa à medula óssea nos transplantes autólogos e, mais recentemente, nos alogênicos. Esta revisäo tem como objetivo discutir alguns aspectos inerentes aos transplantes alogênicos periféricos como as caracterísisticas fenotípicas, funcionais e biológicas das células mobilizadas; composiçäo celular do produto da aférese; utilizaçäo do fator de crescimento em doadores normais, resultados clínicos, enfocando a cinética de pega, doença do enxerto contra o hospedeiro aguda e crônica. Ainda existem algumas dúvidas quanto a utilizaçäo rotineira deste tipo de transplante. Os benefícios dos transplantes com células progenitoras periféricas já conhecidos como, pega mais rápida, provável diminuiçäo da mortalidade precoce e uma potencial reduçäo das recidivas deveriam alterar a metodologia padräo dos transplantes? Talvez ainda näo, pelo risco de uma maior incidência da doença do enxerto contra o hospedeiro, uma doença grave e difícil de tratar. Assim, as perspectivas futuras deveräo incluir metodologias de manipulaçäo celular que permitam manter as vantagens já existentes, porém com menos doença do enxerto contra o hospedeiro.(AU)``