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  • 1
    ISSN: 1569-8041
    Keywords: chronic lymphocytic leukemia ; hematopoietic stem cell transplantation ; minimal residual disease ; molecular remissions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Stem-cell transplantation is a reasonable therapeutic approach for younger patients with high-risk CLL. Patients and methods: Twelve patients (seven males; median age 47 years, range 29–51) with high-risk CLL underwent transplantation (allo, n = 7; auto, n = 5). The conditioning regimen consisted of cyclophosphamide and total body irradiation in 11 patients, and BEAC in the remaining one. Minimal residual disease (MRD) was assessed by cytofluorometry and PCR. Results: All 11 evaluable patients engrafted. Of the seven allografted patients, two died of treatment-related causes; three patients developed acute GVHD. No transplant-related mortality was observed in autografted patients. After transplantation, 10 of 11 patients evaluable for response achieved CR (91%; 95% CI 59%–100%) which was molecular in nine patients (82%; 95% CI 48%–98%). One patient in CR but MRD+ relapsed nine months after transplantation and died. Seven patients remain in molecular CR for a median of 16 months (range 1–58). Estimated actuarial survival and disease-free survival at two years is 81% (95% CI 43%–100%) and 71% (95% CI 43%–99%), respectively. Relapse risk at two years is 12.5% (95% CI 0%–35.5%). Conclusions: Patients with high-risk CLL can achieve long-lasting molecular CR after SCT. The role of transplants in CLL management deserves investigation in controlled trials.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0584
    Keywords: Key words Peripheral blood progenitor cells ; Allogeneic transplantation ; G-CSF ; Healthy donor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The effects of both daily G-CSF administration and subsequent peripheral blood progenitor cell collection (PBPCC) by apheresis on 20 healthy adult donors were studied. All received daily G-CSF (filgrastim) 10 μg/kg for 5–7 days by subcutaneous injection. G-CSF administration was well tolerated, except for moderate bone pain and headache. Peak values of CD34+ cells were observed on days 5 (n=12) or 6 (n=8). In all donors a significant increase in CD3+, CD4+, CD8+, CD19+, and NK cells was observed on day 5 in relation to the baseline values. CD4/CD8 lymphocyte ratio was unmodified by G-CSF. None of the donors required a central venous line for PBPCC. Immediately after PBPCC, a platelet count below 100×109/l was observed in nine of 18 cases, although in all donors platelet counts were over 100×109/l 7 days later. A lymphocytopenia on day 7 following PBPCC was observed, although there was a tendency to achieve baseline values 30–90 days after the procedure. Mean numbers (±SD) of collected cells ×106/kg after a median of two (1–4) apheresis sessions and a median of 20 l (10–40) processed were: CD34+ 5.5 (±2.3), CD3+ 326 (±105), CD4+ 207 (±64), CD8+ 164 (±60), CD19+ 88 (±32), and NK cells 32 (±14). We conclude that G-CSF administration to healthy donors is a well-tolerated procedure which is associated with (a) obtaining a high number of hematopoietic progenitor cells, and (b) a significant increase in T, B, and NK cells in donors' blood. In addition, PBPCC by apheresis results in a moderate, rapidly reversible, and clinically irrelevant thrombocytopenia and a moderate lymphocytopenia, which tends to resolve within 3 months following the procedure.
    Type of Medium: Electronic Resource
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