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Abstract
Peripheral blood progenitor cells are being used increasingly as part of the treatment protocol for a variety of haematological malignancies. The most appropriate mobilisation therapy and the optimum collection procedures haw: yet to be fully elucidated, 28 patients with myeloma (9), NHL (II) and HD (8) underwent PBSC mobilisation and harvesting between November 1992 and October 1993. Two protocols were used; the myeloma group received high-dose cyclophosphamide, 7 g/m2 + G-CSF and were leucapheresed on 5 consecutive days during the recovery period using the Haemonetics V50 and the lymphoma group a lower dose of cyclophosphamide, 3 g/m2 + G-CSF followed by leucapheresis on 2 or 3 occasions using, a Cobe Spectra. Median time to achieve a WBC: of 1 × 109/I during the recovery phase, was 14 days (11-16) and 10 days (9-15) respectively. Median numbers of MNC and CFU-GM collected for the myeloma group were 5.9 × 108/kg (2.5-13.5) and 69.4 × 104kg (9.9-268.1) and for the lymphoma group, 5.1 × 108/kg (1.2-11.1) and 35.4 × 104kg (1.2-129.7). Three patients with lymphoma had a low yield of CFU-GM, two of which did not proceed to auto-graft. 'The third patient failed to engraft and died despite receiving bone marrow backup. For the remaining 25 patients, median time to neuts > 0.5 × 109/I and platelets > 50 × 109/I was 9 (8-13) and 11 (9-23) days for the myeloma group and 12 (9-15) and 13 (9-180) days for the lymphomas. We found a strong correlation between CD34+ cells and CFU-CM from the last 9 patients. There is a correlation between CFU-GM infused and speed of engraftment. All patients whom received > 10 × 104 CFU-GM/kg showed a rapid engraftment for neutrophils and platelets. In all cases, when > 4 × 108/kg MNC were harvested, > 10 × 104 CFU-GM/kg were obtained. Sufficient cells for a rapid engraftment can be obtained from 2 leucaphereses in the majority of patients. The recovering peripheral blood WBC provides a good indicator of when to harvest. The target value of CFU-GM can be predicted by the number of cells harvested and by the number of CD34 positive cells in the leucapheresis product.