Cryopreservation of Peripheral Blood Stem Cells (PBSC) with Hydroxyethylstarch (HES) and Dimethylsulfoxide (DMSO) Results in Faster Granulocyte Recovery Than Using Dimethylsulfoxide Alone.

Abstract

PBSC components are routinely frozen for storage before autologous transplantation in the treatment of malignant diseases. We have used 5% DMSO, 3.75% human serum albumin (HSA), 0.2% dextrose with 6% HES for cryopreservation of cells (DMSO/HES), but the lack of a commercial source of HES required us to evaluate other cryopreservative solutions. A solution containing 5% DMSO, 2.25% HSA in normal saline (DMSO) was selected from a range of cryoprotectant solutions based on in vitro data demonstrating equivalence in preservation of hematopoietic colony forming ability to the HES solution previously used at this center. Fifteen months after the change, we performed a retrospective review of engraftment kinetics in autologous PBSC transplantation for the treatment of patients classified by cryoprotectant solution used. PBSC collected before 13-June-2006 were frozen in the DMSO/HES solution. PBSC collected after that date were frozen in DMSO. Patients underwent transplantation using dose-intense preparative regimens appropriate to diagnosis. Filgrastim was administered after transplantation to hasten granulocyte recovery. All patients after the change date were evaluated and patients treated in a similar time frame before the change were selected for comparison. Patient demographics and mean CD34+ cell number infused were similar for these two groups.DemographicsNAgeCD34+ Cells/Kg (xE6)Gender (M:F)Diagnosis (MM:NHL:Other)DMSO/HES122567.659:6375:34:13DMSO103587.155:4879:14:10p Value0.260.560.170.84Shown are median age and mean CD34+ cells/kg transplanted. Diagnosis is MM=multiple myeloma, NHL=non-Hodgkin's lymphoma, and Other = other hematological malignancies.Patients who received PBSC frozen in DMSO/HES achieved a significant one-day faster granulocyte recovery but similar platelet recovery compared to patients receiving PBSC frozen in DMSO.Engraftment KineticsNANC>500ANC>1000Platelet>20,000DMSO/HES122111213DMSO103121314p Value<0.0010.0020.83Shown are median days to achieve particular endpoint of engraftment.Despite similar in vitro and patient demographic profiles, these data indicate that the combination cryoprotectant solution results in a clinically significant enhancement in speed of engraftment, resulting in a one (1) day reduction in hospital stay associated with the transplant regimen. The effect appears to be lineage-specific. Other modifications of cryoprotectant solutions may achieve yet faster engraftment, benefiting patients undergoing autologous PBSC transplantation by shortening the period of marrow hypoplasia. These results agree with another study of cryopreservation with and without HES (Rowley, et al. Bone Marrow Transpl 2003; 31:1043–51).