Bloodless (transfusion-free) hematopoietic stem cell transplants: the Mexican experience

Abstract

Summary:We have analyzed the transfusion requirements of a group of 132 peripheral blood stem cell transplants from a single institution (73 allografts and 59 autografts) over a 10-year period. The allografts were conducted using the 'Mexican' nonmyeloablative conditioning regimen, while the autografts were given single-day high-dose melphalan. For the allografts, the median number of transfused packed red blood (PRBC) cell units was 1 (range 0-22), while the median number of platelet transfusion (PLT) sessions was 1 (range 0-9); 45% of allografted individuals did not require PRBC transfusions and 35% did not require PLT. For autografts, the median number of PRBC units was 2 (range 0-21), while the median number of PLT was 2 (range 0-21); 33% of autografted individuals did not require PRBC and 25% did not require PLT. We conclude that, by using certain preparative regimens, both allo and auto hematopoietic stem cell grafts can be conducted without the transfusion of blood products. Bone Marrow Transplantation (2005) 36, 715-720.

Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

“…By the same token, the transfusion requirements of the patients allografted with this method are very low [26,27], and the complications stemming from cytomegalovirus reactivation are exceptional [21,22]. Along the same line, the 100-day mortality is 16%, a figure which contrasts with that of conventional allografting than can go up to 50% [2].…”

“…Since the duration of both granulocytopenia and thrombocytopenia during NST is shorter than those during autologous stem cell transplants or during myeloablative chemotherapy, we elected to conduct NST on an outpatient basis provided that certain conditions are fulfilled: Only patients asymptomatic, fully active, able to stay in their homes, with relatives or friends or in nearby-hotels, and with a fair educational level can be offered this program; fundamental to the success of this approach is the availability of a 7 day-a-week clinic where medications and transfusions can be rapidly and efficiently provided [23,27]. In our experience in 193 patients, only 22% were hospitalized, mainly because the development of fever or mucositis.…”

SCT in Jehovah's Witnesses: the bloodless transplant

“…Weissinger et al 25 report that when RBCs were given for symptoms or for a hematocrit below 26%, only 63% of the 40 patients required RBC transfusion. Ruiz-Arguelles et al 36 were able to avoid RBC transfusion in 45% of their allografted patients receiving non-myeloablative conditioning. Aggressive treatment of bleeding and optimal supportive care could substantially improve this percentage.…”

“…54 A pre-transplant Hb of above 12 g per 100 ml should be obtained in patients refusing transfusion; EPO-stimulating agents (ESAs) and intravenous iron should be used aggressively during the pretransplant period to hasten response and minimize delay. Ruiz-Arguelles et al 36 were able to avoid RBC transfusion in 33% of their autografted patients by transfusing only for symptomatic anemia.…”

“…Their institution has compiled experience with conservative transfusion strategies for 59 autologous transplants and 73 non-myeloablative transplants. 36 Plts were transfused for platelet counts below 10 Â 10 9 /l, or for o20 Â 10 9 /l if there was bleeding.…”