Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution
Abstract Background High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. However, the collection of sufficient peripheral blood stem cell (PBSC) grafts can be challenging, and the question arises wheth...
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doaj-f6bd1b68eb704a78a1561541eb8610cc2020-11-25T02:01:34ZengBMCBMC Cancer1471-24072020-04-0120111110.1186/s12885-020-06873-7Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitutionSandra Sauer0Petra Pavel1Anita Schmitt2Martin Cremer3Mark Kriegsmann4Thomas Bruckner5Karin Jordan6Patrick Wuchter7Carsten Müller-Tidow8Katharina Kriegsmann9Department of Hematology, Oncology and Rheumatology, Heidelberg UniversityStem Cell Laboratory, IKTZ Heidelberg GmbHDepartment of Hematology, Oncology and Rheumatology, Heidelberg UniversityDepartment of Hematology, Oncology and Rheumatology, Heidelberg UniversityInstitute of Pathology, Heidelberg UniversityInstitute of Medical Biometry and Informatics, Heidelberg UniversityDepartment of Hematology, Oncology and Rheumatology, Heidelberg UniversityInstitute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg – HessenDepartment of Hematology, Oncology and Rheumatology, Heidelberg UniversityDepartment of Hematology, Oncology and Rheumatology, Heidelberg UniversityAbstract Background High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. However, the collection of sufficient peripheral blood stem cell (PBSC) grafts can be challenging, and the question arises whether reinfusion of low-dose grafts will lead to a hematopoietic recovery. Methods The hematopoietic recovery of 148 MM patients who underwent HD melphalan chemotherapy and received PBSC transplants with varying CD34+ cells doses (3–4 × 106 [n = 86], 2–2.5 × 106 [n = 53], < 2 × 106 [n = 9] per kg body weight [bw]) was analyzed in this retrospective single-center study. Results All patients reached hematopoietic reconstitution, even those who received < 2 × 106 CD34+ cells/kg bw. 62 (42%) patients received granulocyte-colony-stimulating factor (G-CSF). The median duration to leukocyte recovery ≥1.0 × 109/L was 12 days in every group. The median duration to platelet recovery ≥20 × 109/L was 11, 13 and 13 days, respectively. In the multivariate analysis, a low number of reinfused CD34+ cells was associated with prolonged time until leukocyte reconstitution (p = 0.010, HR 0.607) and platelet recovery (p < 0.001, HR 0.438). G-CSF support significantly accelerated leukocyte (p < 0.001, HR 16.742) but not platelet reconstitution. Conclusion In conclusion, reinfusion of low- and even very-low-dose PBSC grafts leads to sufficient hematopoietic reconstitution. No severe adverse events were observed during or after HD chemotherapy and ASCT in the analyzed cohort. While the impact of CD34+ cell dose is marginal, G-CSF significantly accelerates the leukocyte recovery.http://link.springer.com/article/10.1186/s12885-020-06873-7Peripheral blood stem cellsInsufficient graftAutologous stem-cell transplantationMultiple myeloma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sandra Sauer Petra Pavel Anita Schmitt Martin Cremer Mark Kriegsmann Thomas Bruckner Karin Jordan Patrick Wuchter Carsten Müller-Tidow Katharina Kriegsmann |
spellingShingle |
Sandra Sauer Petra Pavel Anita Schmitt Martin Cremer Mark Kriegsmann Thomas Bruckner Karin Jordan Patrick Wuchter Carsten Müller-Tidow Katharina Kriegsmann Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution BMC Cancer Peripheral blood stem cells Insufficient graft Autologous stem-cell transplantation Multiple myeloma |
author_facet |
Sandra Sauer Petra Pavel Anita Schmitt Martin Cremer Mark Kriegsmann Thomas Bruckner Karin Jordan Patrick Wuchter Carsten Müller-Tidow Katharina Kriegsmann |
author_sort |
Sandra Sauer |
title |
Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
title_short |
Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
title_full |
Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
title_fullStr |
Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
title_full_unstemmed |
Low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
title_sort |
low-dose peripheral blood stem cell graft after high-dose chemotherapy - an evaluation of hematopoietic reconstitution |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2020-04-01 |
description |
Abstract Background High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. However, the collection of sufficient peripheral blood stem cell (PBSC) grafts can be challenging, and the question arises whether reinfusion of low-dose grafts will lead to a hematopoietic recovery. Methods The hematopoietic recovery of 148 MM patients who underwent HD melphalan chemotherapy and received PBSC transplants with varying CD34+ cells doses (3–4 × 106 [n = 86], 2–2.5 × 106 [n = 53], < 2 × 106 [n = 9] per kg body weight [bw]) was analyzed in this retrospective single-center study. Results All patients reached hematopoietic reconstitution, even those who received < 2 × 106 CD34+ cells/kg bw. 62 (42%) patients received granulocyte-colony-stimulating factor (G-CSF). The median duration to leukocyte recovery ≥1.0 × 109/L was 12 days in every group. The median duration to platelet recovery ≥20 × 109/L was 11, 13 and 13 days, respectively. In the multivariate analysis, a low number of reinfused CD34+ cells was associated with prolonged time until leukocyte reconstitution (p = 0.010, HR 0.607) and platelet recovery (p < 0.001, HR 0.438). G-CSF support significantly accelerated leukocyte (p < 0.001, HR 16.742) but not platelet reconstitution. Conclusion In conclusion, reinfusion of low- and even very-low-dose PBSC grafts leads to sufficient hematopoietic reconstitution. No severe adverse events were observed during or after HD chemotherapy and ASCT in the analyzed cohort. While the impact of CD34+ cell dose is marginal, G-CSF significantly accelerates the leukocyte recovery. |
topic |
Peripheral blood stem cells Insufficient graft Autologous stem-cell transplantation Multiple myeloma |
url |
http://link.springer.com/article/10.1186/s12885-020-06873-7 |
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