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Analysis of engraftment kinetics in pediatric patients undergoing autologous PBPC transplantation
1Department of Pediatric Hematology and Oncology, Hospital Niño Jesús, Autonomous University of Madrid, Spain.
Insights
The number of CD34+ cells infused is key for hematopoietic recovery after stem cell transplant. A dose of at least 5 x 10^6/kg CD34+ cells is optimal for rapid neutrophil and platelet engraftment in pediatric patients.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Autologous peripheral blood progenitor cell (PBPC) transplantation is a common procedure for pediatric patients with hematologic malignancies and solid tumors.
- Filgrastim (G-CSF) is frequently used to mobilize PBPCs, but factors influencing engraftment kinetics require further analysis.
Purpose of the Study:
- To analyze factors affecting engraftment kinetics after autologous PBPC transplantation in pediatric patients.
- To identify the most significant predictors of neutrophil and platelet recovery post-transplantation.
Main Methods:
- Retrospective analysis of 46 pediatric patients undergoing autologous PBPC transplantation.
- PBPC mobilization with filgrastim (G-CSF) alone, with G-CSF administered post-infusion.
- Univariate and multivariate analyses to examine factors influencing engraftment.
Main Results:
- All patients achieved rapid hematopoietic recovery, with median times of 9 days for neutrophils and 15 days for platelets.
- The infused dose of CD34+ cells was the most significant predictor of both neutrophil and platelet engraftment (p < 0.001).
- Patients receiving >= 5 x 10^6/kg CD34+ cells showed significantly faster hematopoietic recovery.
Conclusions:
- The CD34+ cell dose is the primary determinant of engraftment kinetics following PBPC transplantation.
- A CD34+ cell dose of >= 5 x 10^6/kg appears optimal for ensuring rapid neutrophil and platelet recovery in pediatric patients.
- While a minimal effective dose could not be precisely defined, higher CD34+ cell doses are associated with improved engraftment outcomes.
Abstract:
We sought to analyze factors that affect the engraftment kinetics following autotransplantation with PBPC mobilized by filgrastim (G-CSF). Forty-six consecutive pediatric patients with hematologic malignancies (n = 23) or solid tumors (n = 23) underwent autologous PBPC transplantation after myeloablative therapy. PBPC were mobilized using G-CSF alone. All patients received G-CSF after PBPC infusion. Factors potentially influencing the neutrophil and platelet engraftment were examined using univariate and multivariate analysis. All patients experienced rapid hematopoietic recovery, with a median of 9 days (range 7-15) to achieve a neutrophil count of 0.5 x 10(9)/L and a median of 15 days (range 9-37) to achieve a platelet count of 20 x 10(9)/L. The most important predictive factor of both platelet (p = 0.002) and neutrophil (p = 0.0001) recovery was the number of CD34+ cells infused. Patients receiving > or =5 x 10(6)/kg CD34+ cells had a more rapid hematopoietic recovery (p < 0.001) than those receiving a lower cell dose. The CD34+ cell dose is the most important predictive factor for engraftment kinetics after PBPC transplantation. Although a minimal CD34+ cell dose could not be defined, a dose > or =5 x 10(6)/kg CD34+ cells may be optimal to ensure rapid neutrophil and platelet recovery.