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A marrow harvest procedure under local anesthesia
Abstract:
This report details a bone marrow harvest procedure performed outside the hospital setting under local anesthesia, thereby avoiding many of the risks associated with the traditional surgical procedure. In approximately 30 minutes, 450 milliliters of marrow can be collected from eight bone punctures, containing a median of 4.18 x 10(9) cells and 33 x 10(6) progenitor cells as defined by CD34 expression. Reinfusion of a median 1.2 x 10(6) CD34+ cells/kg in 10 breast cancer and lung cancer patients after dose-intensive chemotherapy resulted in the recovery of granulocytes > 100/mm3 by day 14 and platelets > 20,000 by day 21. Without progenitor cell support, such recoveries could take 30 and 40 days, respectively. Collection of marrow using this protocol does not compromise the engraftment capability of the progenitor cells, seldom necessitates blood product support, is safer for the patient, and reduces the cost of harvesting by 75% compared to inpatient or day surgery procedures.
Insights
This study presents a safe, cost-effective outpatient bone marrow harvest technique. This method accelerates recovery of blood cells, like granulocytes and platelets, after chemotherapy in cancer patients.
Area of Science:
- Oncology
- Hematology
- Surgical Procedures
Background:
- Traditional bone marrow harvest procedures carry significant risks and costs due to their inpatient surgical nature.
- Autologous stem cell transplantation is a crucial supportive care modality in oncology.
Purpose of the Study:
- To describe an alternative bone marrow harvest technique performed in an outpatient setting under local anesthesia.
- To evaluate the safety, efficacy, and cost-effectiveness of this novel bone marrow harvest protocol.
Main Methods:
- Bone marrow was collected from eight puncture sites in an outpatient setting using local anesthesia.
- Collected marrow was analyzed for total nucleated cells and CD34+ progenitor cells.
- The harvested progenitor cells were reinfused into 10 cancer patients post-chemotherapy.
Main Results:
- Approximately 450 mL of marrow was collected in 30 minutes, yielding a median of 4.18 x 10^9 cells and 33 x 10^6 CD34+ progenitor cells.
- Reinfusion of CD34+ cells resulted in rapid recovery of granulocytes (median day 14) and platelets (median day 21).
- This outpatient method reduced harvest costs by 75% compared to traditional procedures and demonstrated comparable engraftment capability.
Conclusions:
- Outpatient bone marrow harvest under local anesthesia is a safe, efficient, and cost-effective alternative to traditional methods.
- This technique significantly accelerates hematologic recovery in cancer patients undergoing dose-intensive chemotherapy.
- The protocol preserves the engraftment potential of hematopoietic progenitor cells, reducing the need for blood product support.