Granulocyte colony-stimulating factor alone at 12 μg/kg twice a day for 4 days for peripheral blood progenitor cell priming in pediatric patients

Abstract

Summary:In children, the optimal mobilization schedule for harvesting peripheral blood progenitor cells (PBPC) is an issue of continuous research. We have studied a schedule based on high and daily divided doses of G-CSF (12 g/kg body weight twice daily) for 4 days for PBPC priming. Toxicity related to G-CSF was observed in 13 patients (23%), mainly mild bone pain and myalgia. The median CD34 + cell number collected was 4.4 (0.4-35 ؋ 10 6 /kg body weight), with 46 patients achieving 2 ؋ 10 6 /kg body weight (83.6%) after a single large volume leukapheresis. In conclusion, this mobilization schedule allows safe and efficient collection of the minimum target CD34 + cell dose in most pediatric patients by only one procedure. Bone Marrow Transplantation (2002) 30, 417-420. doi:10.1038/sj.bmt.1703662 Keywords: G-CSF; priming; LVL; children; mobilization In children, peripheral blood progenitor cells (PBPC) are progressively substituting bone marrow as a source of stem cells for hematopoietic transplantation due to their easier collection and faster engraftment. The optimal mobilization schedule for stem cell harvest is a matter of permanent research, since collecting the maximum dose of CD34 + cells is being proposed in order to facilitate subsequent manipulation and shorten granulocyte and platelet engraftment. Although chemotherapy plus growth factors has been reported repeatedly to result in collecting higher numbers of CD34 + cells than G-CSF alone, it has several disadvantages such as a longer mobilization period, chemotherapy toxicity and febrile neutropenia. Moreover, optimal timing of apheresis is not easily scheduled and this hinders optimal progenitor collection especially in patients referred from other regions.In order to improve the progenitor cell collection in our

Engraftment syndrome after autologous peripheral blood progenitor cell transplantation in pediatric patients: a prospective evaluation of risk factors and outcome

“…Three patients needed admission to intensive care unit (ICU) for mechanical ventilation (MV) and the median time on MV was 37 days (range 25-57). The median time on corticosteroids therapy was 5 days (range [4][5][6][7][8][9][10][11][12][13][14]. In addition to more supportive care, there was a trend toward higher costs in the group of patients who developed ES.…”

“…7 On day þ 5 after mobilization, PBPC collections were performed using a Cobe Spectra cell separator (Cobe, Lakewood, CO, USA) by large-volume leukapheresis through a central venous catheter. Details of apheresis procedures have been previously reported.…”

Hematopoietic progenitor cell mobilization and harvesting in children with malignancies: do the advantages of pegfilgrastim really translate into clinical benefit?

“…23 However, these levels were observed with G-CSF administered at 2 Â 12 mg/kg/d. 4 Splenic rupture has been reported in adults as a potential adverse event following pegfilgrastim injection, 24 but some similar events were reported earlier with non-conjugated G-CSF. 25 The long-term risk of myelodysplasia or selection of a clone has been shown after intensive chemotherapy in ALL, G-CSF being an independent risk factor.…”

“…With nonconjugated G-CSF, dose increase and splitting have been suggested to provide better mobilization compared with the standard regimen of non-conjugated G-CSF at 10 mg/kg/d. 2,4 However, in these series, the success criterion of 5 Â 10 6 CD34 þ cells/kg BW was met in o50% of patients, despite the use of large-volume aphereses. This can be compared with our results (60.7% of success, credibility interval 42-78%).…”

“…With this last regimen, despite the use of large-volume apheresis, two other teams failed to achieve this optimal value in a single apheresis in more than 50% of children. 2,4 Thus, finding more efficient welltolerated strategies remains desirable.…”