Increasing the target number of nucleated cells and administration of r-metHuG-CSF expedite neutrophil engraftment in allogeneic bone marrow transplantation

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SINCE 1960, allogeneic bone marrow transplantation (AlloBMT) has been instituted to treat various malignant or nonmalignant disorders. However, AlloBMT has being increasingly replaced by allogeneic peripheral blood stem cell transplantation (AlloPBSCT) over the past 10 years. As Gratwohl and colleagues reported, AlloPBSCT accounted for 30% of whole allogeneic hematopoietic stem cell transplantations (AlloHSCT) performed in European countries in 1997, whereas all AlloHSCT were bone marrow derived in 1991. Faster neutrophil and platelet engraftment and no risk of general anesthesia for donors seems to be the major reasons for this trend. To obtain faster neutrophil engraftment, and reduce morbidity from infections in the allogeneic bone marrow setting, and because of the relatively prolonged neutropenia compared to AlloPBSCT, G-CSF or GM-CSF have been successfully employed. However, the hematologic recovery provided by AlloBMT has always remained slower than that provided by AlloPBSCT. Lower infectious complications, rapid immunologic recovery, shorter hospitalization stay, and lower cost appear as other advantages of AlloPBSCT. Despite these advantages, AlloPBSCT has certain drawbacks. One of the most serious complication is the concern that AlloPBSCT is associated with an increased incidence and severity of chronic graft-versus-host disease (GVHD) as compared to AlloBMT. Furthermore, whether chronic GVHD decreases relapse rate due to graft-versus-leukemia (GVL) effect in patients undergoing AlloPBSCT remains to be determined. Standards for AlloBMT or AlloPBSCT have not yet been optimized. Therefore, some centers have sought to combine both modalities by giving bone marrow and peripheral blood stem cells. In this report, the results of patients undergoing AlloBMT in which the targeted nucleated cell count was 3 10/kg and in which r-metHuG-CSF was administered after the transplantation are presented. Of interest, our patients had fast neutrophil engraftment, low infectious complications, and an acceptable relapse rate, which are comparable to those in AlloPBSCT as reported in the literature. Chronic GVHD rate seems to be less than that in AlloPBSCT.