A simplified method for stem cell autografting in multiple myeloma: a single institution experience

Abstract

In a 14-year period in a single institution 31 autografts were performed in 26 patients with multiple myeloma (MM), using a simplified and affordable autografting procedure: conducting the grafts on an outpatient basis and avoiding stem cell freezing. Autografts were started on an outpatient basis in all instances, but four patients were admitted to the hospital. Median time to achieve more than 0.5 Â 10 9 /l granulocytes was 27 days, whereas median time to recover above 20 Â 10 9 /l plts was 37 days. CR was achieved in 19 cases and a very good partial response in 6 cases. The 100-day mortality was 9.6%. The overall median post-transplant survival has not been reached, being above 76 months, whereas the 76-month survival is 80%. The median cost of each procedure was US$ 15 000. Survival results were substantially better than those of historical control in a group of patients treated in the same institution with melphalan/prednisone. It is concluded that high-dose therapy rescued with a simplified autologous stem cell graft is a valid, useful and affordable therapeutic option for patients with MM, even with economical restraints.

The Mexican Way: a feasible approach to avoid DMSO toxicity

“…The times to neutrophil as well as platelet recovery observed in our group were markedly shorter than in the group described by Lo´pez-Otero et al, 1 as the melphalan dose in our group was only 100-140 mg/m 2 compared with 200 mg/m 2 and we administered a single dose of 6 mg pegylated filgrastim or a daily dose of 5 mg/kg BW non-pegylated G-CSF from day þ 1 until the WBC count had reached 41000/mL.…”

“…We read with great interest the paper of Lo´pez-Otero et al, 1 in which they describe a feasible approach of using high-dose chemotherapy and autologous transplantation in patients with multiple myeloma without cryopreservation of the PBSCs. In their study, they used a G-CSF-based steady-state mobilization strategy immediately followed by a single dose of high-dose melphalan (200 mg/m 2 , day À1) and transplantation of the fridge-stored ( þ 4 1C) autologous, unmanipulated PBSCs on day 0.…”

A Feasibility Study of the Full Outpatient Conduction of Hematopoietic Transplants in Persons with Multiple Sclerosis Employing Autologous Non-Cryopreserved Peripheral Blood Stem Cells

“…The mortality rate of autologous HSCT had been used as an argument against the procedure, but it has decreased substantially as the result of several changes done to the autografting procedures. We and others have shown in hematological malignancies that the mortality rate of the autotransplants can be substantially lowered to figures below 5% [9,14,15,16,17] if the transplant procedures are conducted with PBSC on an outpatient basis and using non-frozen, non-thawed stem cells [7,8,9]. After gaining expertise since 1993 autografting patients with hematological malignancies, mainly multiple myeloma [15] and lymphomas [21], we embarked on a pilot study to assess the feasibility of conducting autografts in patients with MS, considering that these individuals had never been exposed to chemotherapy and that in turn, would both mobilize stem cells and recover hematopoiesis more promptly than individuals previously exposed to chemotherapeutic agents.…”

“…All these changes have turned the practice of autografting in our hands in an affordable procedure, which can be offered to individuals living in underprivileged circumstances such as those prevailing in developing countries [17]. Having gained experience autografting hematological malignancies [8,9,15], we have enrolled in a program of grafting non-cryopreserved autologous hematopoietic stem cells in patients with MS, employing a modification of the autografting conditioning regimen used in malignant diseases. In this study, we report the results of a feasibility study on how to conduct, on an outpatient basis and using non-frozen PBSCs, autologous hematopoietic stem cell transplants in individuals with MS.…”

“…Within the subset of autologous HSCT, the salient features of our method is that we conduct them on an outpatient basis [8,9,15,16], we avoid freezing and thawing the hematopoietic cells in order to both increase viability of hematopoietic cells in the graft as well as to reduce costs [8,9,15,16], and we always employ peripheral blood stem cells (PBSCs). All these changes have turned the practice of autografting in our hands in an affordable procedure, which can be offered to individuals living in underprivileged circumstances such as those prevailing in developing countries [17].…”