Hematologic Recovery in Patients Who Are Treated With Autologous Stem Cells Transplantation Taken From Bone Marrow After Granulocyte–Colony-Stimulating Factor Stimulation

Abstract

Background We sought to compare hematologic recovery between patients who did or did not receive granulocyte–colony-stimulating factor (G-CSF)-stimulated bone marrow (rich bone marrow [RBM]). Materials and Methods The study subjects were 20 patients whose bone marrow was taken without prior stimulation with G-CSF and 15 patients in whom bone marrow was taken after previous G-CSF mobilization. The bone marrow harvest took place on the fifth day after G-CSF initiation. The bone marrow aliquot was 20 mL/kg. Results The median value of nucleated cells obtained from patients without G-CSF preparation was 3.65 × 10 8/kg. The median value of nucleated cells from RBM patients was 4.83 × 10 8/kg. The median value of stem cells obtained from patients without G-CSF preparation was 0.96 × 10 6/kg versus 1.9 × 10 6/kg from RBM patients. The median time to recovery of the hematopoietic system based on an increase in PLT value >20 g/L was 12.6 days for RBM versus 18.8 days without G-CSF preparation. The median time to recovery of the hematopoietic system based on assessment of growth ANC>0.5 g/L was 13.0 days for RBM versus 17.8 days without G-CSF stimulation. Significantly higher values of nucleated cells and increased stem cells were observed among RBM patients compared with those whose bone marrow was harvested without any stimulation ( P = .01). There was faster recovery of the hematopoietic system in cases where bone marrow was collected after G-CSF: PLT >20 g/L ( P = .015) and ANC >0.5 g/L ( P = .01). We also observed that the use of stimulated bone marrow shortened hospital stay after the administration of hematopoietic cells to 17.3 days compared with 23.1 days among patients receiving hematopoietic cells from nonstimulated bone marrow. The number of complications during transplantation was comparable in both cases, the most frequent ones being febrile neutropenia and grade III and IV mucositis. Conclusion RBM is a better method to obtain stem cells from bone marrow. Stimulated bone marrow shows faster engraftment compared with nonstimulated bone marrow helping patients who fail to generate are adequate number of stem cells from peripheral blood.