Advantages of non-cryopreserved autologous hematopoietic stem cell transplantation against a cryopreserved strategy

Abstract

Autologous stem cell transplantation (auto-HSCT) is an effective treatment strategy for hematological malignancies. The standard mode of handling hematopoietic progenitors for the autologous procedure (CRYO) consists on its collection and freezing with dimethyl sulfoxide (DMSO) and its subsequent thawing and re-infusion. This process is toxic and expensive. Non-cryopreserved (non-CRYO) is a less expensive mode of auto-HSCT. We designed a comparative study between both strategies performed in two different centers to analyze the short-term complications. In total 111 auto-HSCT were performed from January/2015 to October/2016 (42 non-CRYO and 74 CRYO). There were 74 males and 69 (62%) patients had the underlying diagnosis of multiple myeloma. No differences were seen on the characteristics of the apheresis products and their viability. Engraftment was significantly faster in the non-CRYO group (p = 0.001). Febrile neutropenia and severe mucositis were lower in the non-CRYO group (40% vs 92% p = 0.0001 and 11% vs 64%, p = 0.001, respectively). In addition, length of hospitalization was 5 days shorter in the non-CRYO group (p = 0.0001). Overall responses and transplantation outcomes were similar. Our data demonstrate a clear advantage of the non-CRYO over CRYO auto-HSCT with faster engraftment, lower incidence of febrile neutropenia and shorter hospital stay after the transplantation procedure. These data are especially relevant for centers with high transplant activity or with limited resources.

Autologous stem cell transplant for high‐risk neuroblastoma: Achieving cure with low‐cost adaptations

“…Another study carried out in two centers in Chile and Spain compared the outcome in patients who underwent ASCT with cryopreserved stem cells (n = 74) and noncryopreserved stem cells (n = 42). A significantly decreased length of hospital stay was observed in the noncryopreserved group at 15 days versus 20 days in the cryopreserved group, accounted by significantly lower febrile neutropenia (40% vs 92%), mucositis (11% vs 64%), and the requirement for total parenteral nutrition (3% vs 16%) 38 . The current study provides further evidence supporting the use of noncryopreserved stem cells for ASCT in patients with HR‐NB.…”

“…The cost of stem cell cryopreservation to the patient in India varies from 300 to 700 USD. We did not cryopreserve the stem cells in our cohort, as there was enough literature in support 37‐40 . Besides, it helped financially.…”

Hematopoietic stem cell transplantation using non-cryopreserved peripheral blood stem cells graft is effective in multiple myeloma and lymphoma

“…Hematopoietic stem cells remain viable for several days at 4°C storage [3,4]. Studies with non-cryopreserved HSCs are limited [1,2,[5][6][7][8]. In support of these, we report the outcome of ASCT in MM and lymphoma with mobilized non-cryopreserved peripheral blood stem cell (PBSC) graft in 76 patients in terms of feasibility, safety, and efficacy.…”

“…Another study has in fact demonstrated that noncryopreserved stem cells are superior to cryopreserved stem cells with faster engraftment, lower incidence of febrile neutropenia and shorter hospital stay after the transplantation procedure [2].…”

“…These guidelines pertain to cryopreserved stem cell dose. Sarmiento et al [2] have already demonstrated superiority of non-cryopreserved HSCs over cryopreserved HSCs. Our 14 patients were admitted to transplant unit with HSC dose <2 million/kg.…”