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Experience with peripheral blood stem cell collection for autografts in children with active cancer
1Department of Pediatrics, University Hospital of Tokushima, Japan.
Insights
Peripheral blood stem cell (PBSC) harvesting for autografts in children with cancer is safe and reliable. Younger patient age predicted better stem cell collection yields, with high-dose cytarabine effective for mobilization.
Area of Science:
- Pediatric Oncology
- Hematology
- Stem Cell Transplantation
Background:
- Autologous transplantation using peripheral blood stem cells (PBSC) is a critical treatment modality for pediatric cancers.
- Assessing the efficacy and safety of PBSC harvesting in pediatric populations is essential for optimizing treatment protocols.
Purpose of the Study:
- To evaluate the laboratory and clinical outcomes of PBSC harvesting for autografts in children with cancer.
- To identify factors influencing successful stem cell collection and assess procedure safety.
Main Methods:
- A total of 215 apheresis procedures were performed on 61 pediatric cancer patients using a CS 3000 cell separator.
- The methylcellulose progenitor assay was employed to quantify colony-forming units-granulocyte/macrophage (CFU-GM).
- Multivariate analysis was used to determine predictors of CFU-GM yield.
Main Results:
- Successful collection of >= 3 x 10(5) CFU-GM/kg was achieved in 44% of patients, and >= 1 x 10(5) CFU-GM/kg in 65%.
- Younger patient age was the sole significant predictor of higher CFU-GM yield (p = 0.009).
- High-dose cytarabine regimens demonstrated efficacy in mobilizing stem cells in children with acute leukemia or non-Hodgkin's lymphoma.
Conclusions:
- PBSC harvesting for autografts in children with active cancer is a safe and reliable procedure.
- Patient age is a key factor influencing stem cell collection efficiency.
- Optimized mobilization strategies, such as high-dose cytarabine, can enhance stem cell yields in specific pediatric cancer types.
Abstract:
This report examines laboratory and clinical experience with peripheral blood stem/progenitor cell harvest for autografts in 71 consecutively referred children with various types of cancer from one institution. The age of the patients ranged from 7 months to 17 years with a median of 8 years. Ten of the 71 referred children were removed from the collection procedure because of failure to induce clinical remission (nine) or deteriorating chemotherapy-induced liver failure (one). A total of 215 aphereses were performed on a CS 3000 cell separator in 61 patients, including 18 children aged 4 years or less. The methylcellulose progenitor assay was used as an index of stem cell collection. A minimum of greater than or equal to 3 x 10(5) colony-forming units-granulocyte/macrophage (CFU-GM)/kg body weight were collected in 31 of 71 children (44%) with a mean of 3.1 (range, 1-5) aphereses, and greater than or equal to 1 x 10(5) CFU-GM/kg in 46 children (65%). The incidence of serious morbidity was low. When apheresis or chemotherapy was repeated, the progenitor yields decreased rapidly. By multivariate analysis, the age of the patients was the only significant predictor of CFU-GM yield (p = 0.009). In our experience with 12 children with acute leukemia or non-Hodgkin's lymphoma, regimens containing high-dose cytarabine (2.0 g/m2 x 10) were effective for mobilization. Our results extend the earlier findings that harvesting PBSCs for autografts in children with active cancer is a safe and reliable procedure with a low incidence of serious morbidity.