High dose therapy and autologous bone marrow versus blood cell rescue. South Island Bone Marrow Transplant Unit
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G R Hill1, A Inder, W N Patton
1Christchurch Hospital, Christchurch.
Aims:
To compare haematological recovery and supportive care requirements for patients receiving high dose therapy (HDT) supported by rescue with either autologous cytokine mobilised blood cells (BC) or autologous bone marrow (BM). To identify stem cell harvest criteria predictive of rapid haematological recovery after rescue with BC.
Methods:
Single arm, open study in four groups of 69 consecutive patients undergoing HDT in a single institution from 1986-95. Group 1 contained patients with solid tumours or myeloma rescued with BC alone (n = 14); group 2 patients with solid tumours rescued with BM (n = 31); group 3 patients with acute leukaemia rescued with BM (n = 21); and group 4 patients with solid tumours rescued with both BC and BM (n = 3).
Results:
Haemopoietic recovery was most rapid for group 1 where, in comparison with the BM group transplanted for similar disease (group 2), highly significant reductions were observed for median days to 1) neutrophil s >/= 0.5 x 10(9)L (12 v 22; p 0.0001); 2) neutrophils >/= 1.0 x 10(9)/L (14 v 27 ; p = 0.0001); platelets >/= 20 x 10(9) /L (11 v 20; p = 0.0005); and 4) platelets >/= 50 x 10(9)/L (15 v 27; p = 0.001). Similar significant reductions for the BC group over group 2 were also observed for median, (1) inpatient days (22 v 30; p = 0.0001); (2) red cell transfusions (2 v 5; p = 0.01) ; (3) platelet transfusions (2 v 6; p = 0.0001); (4) days of fever (2 v 8; p = 0.001); and (5) days on IV antibiotics (8 v 14; p = 0.02). Group 3 patients yielded data either similar to or less advantageous to that in group 2 and group 4 patients yielded data intermediate between groups 1 and 2. Data from BC harvests suggested that yields of CD34+ cells of > 2.0 x 10(6)/kg and/or of colony forming units-granulocyte-macrophage (CFU-GM) of > 6.0 x 10(4)/kg were predictive of rapid haemopoietic recovery.
Conclusion:
For haemopoietic rescue following single HDT for solid tumours BC has considerable advantages over BM.