Apheresis in developing countries around the World.

At the combined American Society for Apheresis (ASFA) Annual Meeting/World Apheresis Association (WAA) Congress in San Francisco, California, in April of 2014, the opening session highlighted the status of apheresis outside of the United States. The organizers invited physicians active in apheresis in countries not usually represented at such international gatherings to give them a forum to share their experiences, challenges, and expectations in their respective countries with regard to both donor and therapeutic apheresis. Apheresis technology is expensive as well as technically and medically demanding, and low and median income countries have different experiences to share with the rest of the world. Apheresis procedures also require resources taken for granted in the developed world, such as reliable electrical power, that can be unpredictable in parts of the developing world. On the other hand, it was obvious that there are significant disparities in access to apheresis within the same country (such as in Brazil), as well as between neighboring nations in Africa and South America. A common trend in the presentations from Brazil, Indonesia, Malaysia, Nigeria, and South Africa, was the need for more and better physicians and practitioners' training in the indications of the various apheresis modalities and patient oversight during the procedures. As ASFA and WAA continue to work together, and globalization allows for increased knowledge-sharing, improved access to apheresis procedures performed by qualified personnel with safety and high-quality standards will be increasingly available.

Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas.

OBJECTIVE: To evaluate the use of high-dose sequential chemotherapy in a Brazilian population. METHODS: High-dose cyclophosphamide followed by autologous hematopoietic stem cell transplantation is an effective and feasible therapy for refractory/relapsed lymphomas; this regimen has never before been evaluated in a Brazilian population. All patients (106 with high-grade non-Hodgkin lymphoma and 77 with Hodgkin's lymphoma) submitted to this treatment between 1998 and 2006 were analyzed. Chemotherapy consisted of the sequential administration of high-dose cyclophosphamide (4 or 7 g/m(2)) and granulocyte-colony stimulating factor (300 µg/day), followed by peripheral blood progenitor cell harvesting, administration of etoposide (2g/m(2)) and methotrexate (8 g/m(2) only for Hodgkin's lymphoma) and autologous hematopoietic stem cell transplantation. RESULTS: At diagnosis, non-Hodgkin lymphoma patients had a median age of 45 (range: 8-65) years old, 78% had diffuse large B-cell lymphoma and 83% had stage III/IV disease. The Hodgkin's lymphoma patients had a median age of 23 (range: 7-68) years old, 64.9% had the nodular sclerosis subtype and 65% had stage III/IV disease. Nine Hodgkin's lymphoma patients (13%) and 10 (9%) non-Hodgkin lymphoma patients had some kind of cardiac toxicity. The overall survival, disease-free survival and progression-free survival in Hodgkin's lymphoma were 29%, 59% and 26%, respectively. In non-Hodgkin lymphoma, these values were 40%, 49% and 31%, respectively. High-dose cyclophosphamide-related mortality was 10% for Hodgkin's lymphoma and 5% for non-Hodgkin lymphoma patients. High-dose cyclophosphamide dosing had no impact on toxicity or survival for both groups. CONCLUSIONS: Despite a greater prevalence of poor prognostic factors, our results are comparable to the literature. The incidence of secondary neoplasias is noteworthy. Our study suggests that this approach is efficient and feasible, regardless of toxicity-related mortality.

Clinical and histomorphometric evaluation of extraction sockets treated with an autologous bone marrow graft.

PURPOSE: The aim of this study was to evaluate the potential of an autologous bone marrow graft in preserving the alveolar ridges following tooth extraction. MATERIALS: Thirteen patients requiring extractions of 30 upper anterior teeth were enrolled in this study. They were randomized into two groups: seven patients with 15 teeth to be extracted in the test group and six patients with 15 teeth to be extracted in the control group. Hematologists collected 5 ml of bone marrow from the iliac crest of the patients in the test group immediately before the extractions. Following tooth extraction and elevation of a buccal full-thickness flap, titanium screws were positioned throughout the buccal to the lingual plate and were used as reference points for measurement purposes. The sockets were grafted with an autologous bone marrow in the test sites and nothing was grafted in the control sites. After 6 months, the sites were re-opened and bone loss measurements for thickness and height were taken. Additionally, before implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation. RESULTS: The test group showed better results (P<0.05) in preserving alveolar ridges for thickness, with 1.14+/-0.87 mm (median 1) of bone loss, compared with the control group, which had 2.46+/-0.4 mm (median 2.5) of bone loss. The height of bone loss on the buccal plate was also greater in the control group than in the test group (P<0.05), 1.17+/-0.26 mm (median 1) and 0.62+0.51 (median 0.5), respectively. In five locations in the control group, expansion or bone grafting complementary procedures were required to install implants while these procedures were not required for any of the locations in the test group. The histomorphometric analysis showed similar amounts of mineralized bone in both the control and the test groups, 42.87+/-11.33% (median 43.75%) and 45.47+/-7.21% (median 45%), respectively. CONCLUSION: These findings suggest that the autologous bone marrow graft can contribute to alveolar bone repair after tooth extraction.

Effects of high platelet concentration in collecting and freezing dry platelets concentrates.

OBJECTIVE: To evaluate, in vitro, the effects of collecting and cryopreserving fresh dry platelet concentrates (PCs). MATERIAL AND METHODS: Standard and dry PCs were collected in the same apheresis procedure. PCs were evaluated by mean platelet volume (MPV), pH, glucose and LDH levels. Activation was examined by flow cytometry using anti-CD41, anti-CD42 and anti-CD62p monoclonal antibodies and annexin binding assay. Platelet function was assessed by aggregation using ADP, collagen and arachidonic acid as agonists. Dry PCs were compared to standard PCs and to cryopreserved dry PCs. We also compared the use of ThromboSol to 5% DMSO as cryoprotectives. RESULTS: Dry PCs presented a significantly reduced pH and glucose (p<0.001), increased LDH levels and CD62p expression (p<0.001) and diminished aggregation response to ADP (p<0.001). Platelet cryopreservation was associated with platelet lysis, activation and loss of function. Dry PCs cryopreserved with TS were associated with statistically higher LDH levels (p<0.001) and a higher percentage of annexin binding (p=0.005), in addition to a lower number of CD42 positive platelets (p=0.01). CONCLUSION: Dry PCs should be rapidly frozen after collection to avoid a fall in pH and platelet activation. 5% DMSO performed better than TS to cryopreserve dry PCs.