Collection and composition of autologous peripheral blood stem cells graft in patients with acute myeloid leukemia: influence on hematopoietic recovery and outcome [Skupljanje i sastav transplantata autolognih krvotvornih matičnih stanica periferne krvi u bolesnika s akutnom mijeloičnom leukemijom: utjecaj na hematološki oporavak i ishod]

Raos, Mirela and Nemet, Damir and Bojanić, Ines and Sertić, Dubravka and Batinić, Drago and Dušak, Vesna and Dubravčić, Klara and Mazić, Sanja and Serventi-Seiwerth, Ranka and Mrsić, Mirando and Golubić-Ćepulić, Branka and Labar, Boris (2010) Collection and composition of autologous peripheral blood stem cells graft in patients with acute myeloid leukemia: influence on hematopoietic recovery and outcome [Skupljanje i sastav transplantata autolognih krvotvornih matičnih stanica periferne krvi u bolesnika s akutnom mijeloičnom leukemijom: utjecaj na hematološki oporavak i ishod]. Collegium Antropologicum, 34 (1). pp. 105-115. ISSN 0350-6134

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Abstract

Hematopoietic stem cell (HSC) transplantation is a standard approach in the treatment of hematological malignant diseases. For the last 15 years the main source of cells for trasplantation have been peripheral blood stem cells (PBSC). With the availability of hematopoietic growth factors and understanding the advantages of treatment with PBSC, the application of bone marrow (BM) was supplanted. The aim of this survey was to explore the success of PBSC collection, the factors which influence the success of PBSC collection, the composition and the quality of graft and their infuence on hematopoietic recovery and outcome after transplantation in patients with acute myeloid leukemia (AML). PBSC were collected by the method of leukapheresis after applying a combination of chemotherapy and growth factors or only growth factors. The quality of graft was determined with the clonogenic progenitor cell assay and with the flow citometry analysis. Of the total 134 patients with AML, who were submitted to HSC mobilization, the collection was successful in 78 (58.2%) patients. The collection was more successful after the first than after the second attempt of HSC mobilization (49% vs. 11%). The criteria for effective mobilization were the number of leukocytes >3´109/L and the concentration of CD34+ cells >20´103/mL in the peripheral blood on the first day of leukapheresis. The number of CD34+ cells infused had the strongest impact on hematopoietic recovery. We noted significantly faster hematological recovery of neutrophils and platelets, fewer number of transfused units of red blood cells and platelets, shorter duration of the tranfusion support, shorter treatment with intravenous antibiotic therapy and shorter hospitalization after PBSC compared to BM transplantation. These advantages could provide their standard application in the treatment of patients with AML.

Abstract in Croatian

Transplantacija krvotvornih matičnih stanica (KMS) standardan je pristup liječenja hematoloških zloćudnih bolesti. Unazad 15 godina glavni izvor stanica za transplantaciju čine KMS periferne krvi. Dostupnošću hematopoetskih čimbenika rasta i spoznajom predosti liječenja KMS periferne krvi potisnuta je primjena koštane srži (KS). Svrha ovog rada bila je istražiti učinkovitost skupljanja KMS iz periferne krvi, čimbenike koji utječu na uspješnost skupljanja KMS iz periferne krvi, sastav i kvalitetu transplantata te njihov utjecaj na hematološki oporavak i ishod nakon liječenja transplantacijom u bolesnika s akutnom mijeloičnom leukemijom (AML). U ovom istraživanju KMS periferne krvi skupljane su postupkom leukafereze nakon kombinacije kemoterapije i faktora rasta ili samo faktora rasta. Kvaliteta pripravka KMS određena je metodom kratkotrajne kulture stanica »in vitro« i metodom protočnocitometrijske analize. Od 134 bolesnika s AML, kod kojih je učinjen pokušaj mobilizacije KMS, skupljanje je bilo uspješno kod 78 (58,2%) bolesnika. Skupljanje je bilo uspješnije nakon prvog nego nakon drugog pokušaja mobilizacije KMS (49% vs. 11%). Kriteriji učinkovite mobilizacije bili su broj leukocita >3x109/L i koncentracija CD34+ stanica >20x103/mL u perifernoj krvi na prvi dan leukafereze. Broj infundiranih CD34+ stanica imao je najjači utjecaj na hematološki oporavak. Također smo uočili značajno brži hematološki oporavak neutrofila i trombocita, manji broj transfundiranih doza koncentrata eritrocita i trombocita, brže postizanje neovisnosti o transfuzijama koncentrata eritrocita i trombocita, kraći broj dana intravenskog liječenja antibioticima i kraći boravak u bolnici nakon transplantacije KMS periferne krvi u odnosu na transplantaciju KS. Ove prednosti mogle bi osigurati njihovu standardnu primjenu u liječenju bolesnika s AML.

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