Non‐cryopreserved hematopoietic stem cell transplantation in multiple myeloma, a single center experience

Abstract

Several clinical trials have shown the superiority of high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) over conventional dose therapy for patients with multiple myeloma. There is limited experience with non-cryopreserved autologous hematopoietic stem cell transplantation. Between January 2004 and February 2010, we treated 38 patients with myeloma (mean age = 50.6) with a preparative regimen of Melphalan 140-200 mg/m(2) and non-cryopreserved ASCT. All the apheresis products were kept in a conventional blood bank refrigerator at 4°C for 2 d before infusion. The median time to platelet count of >20 × 10(9) /L was 13 d (range 10-31). Also, the median time to absolute neutrophil count >0.5 × 10(9) /L was 11 d (range 9-21). All the 38 patients were engrafted and there was not graft failure in this study group. Twenty-nine of 38 (76.3%) patients are alive and without disease activity after a median follow-up of 31 months (range 6-77). Responses (complete and partial response) were seen in all the 38 patients. The median progression-free survival was 27 months with 95% confidence interval 23.52-30.48, whereas the median overall survival was 30 months. One hundred days transplant-related mortality was 0%. HDT and autologous transplantation without cryopreservation is an effective and safe method which simplifies the procedure and is feasible and cost saving in our patients.

Worldwide Network for Blood and Marrow Transplantation Recommendations for Establishing a Hematopoietic Stem Cell Transplantation Program in Countries with Limited Resources, Part II: Clinical, Technical, and Socioeconomic Considerations

“…Several reports have described the feasibility of noncryopreserved G-CSF-mobilized whole blood or autologous bone marrow (with or without previous administration of G-CSF). Stem cell graft containing blood units or bone marrow can be stored briefly in a standard blood bank refrigerator at +4°C until infusion [28][29][30].…”

Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma without Cryopreservation

“…Subsequent in vitro and clinical studies on humans showed that bone marrow cells can be preserved in liquid state for 2 to 9 days without significant loss of granulocyte/macrophage-committed progenitor cells providing hematologic reconstitution to patients receiving myeloablative therapy [56]. The technique may be of value in 2 scenarios: (1) use in medical institutions from areas with limited economic resources, that is, having infrastructure to treat hematologic malignancies but not cryopreservation facilities and (2) use in medical institutions treating hematologic malignancies and in the process of establishing an HSCT program that will eventually have cryopreservation capabilities [56–59]. …”

“…Stem cell transfusion 8 to 24 hours following IV administration of melphalan has been reported to be associated with successful grafts. The dose of melphalan can range between 140 and 220 mg/m 2 [56, 59]. In a systemic review of the published studies on noncryopreserved autologous PBSCT in a variety of malignant hematological disorders including MM, the following results were obtained: (1) median time to neutrophil recovery ranged between 9 and 14 days, (2) median time to platelet recovery ranged between 13.5 and 25 days, and (3) hematopoietic reconstitution was universal in all the studies that included 560 patients.…”

“…Treatment-related mortality was reported to range from 0.0 to 13.0%. The deaths reported were due to infections, heart failure, interstitial pneumonitis, and hepatic veno-occlusive disease [56–59, 61]. As stem cells can be stored without cryopreservation for a limited period of time, conditioning therapies for malignant hematological disorders that require administration over 6 days or more should either be excluded or these conditioning therapies should be changed altogether to be administered over 1 to 3 days.…”

Non‐cryopreserved storage is feasible for autologous stem cell transplantation in multiple myeloma previously treated with melphalan

“…To Editor, We read with interest the report on the use of noncryopreserved stem cells in myeloma. (1). We have recently started our stem cell transplantation program and would like to share the successful outcome with conventional storage of stem cells despite having state-of-the-art cryopreservation facility.…”