Autologous Bone Marrow Transplant after Failed Peripheral Blood Stem Cell Mobilization Does Not Adversely Affect Engraftment or Transplant Related Toxicity.
Notice bibliographique
Résumé
Abstract Introduction: Chemotherapy and G-CSF are widely used to collect adequate numbers of peripheral blood stem cells (PBSC) prior to autologous transplant. However, 10–30% of patients (pts) will not mobilize adequately. Alternatives include use of stem cell factor (SCF) and bone marrow (BM) harvest. Limited information is available on the hematopoietic reconstitution and clinical outcome of intensively treated pts who fail to mobilize sufficient numbers of PBSC and receive BM grafts. We sought to determine whether BM is an acceptable source of stem cells in these pts. Methods: We conducted a retrospective analysis of toxicity, engraftment parameters, transfusion requirements and outcome in pts who failed mobilization and underwent unprimed BM harvest at our institution. Results: Between 02/97 and 07/05, 47 heavily pre-treated pts (male/female 22/27; median age 49, range 22–66) who failed mobilization underwent an autologous BM transplant. Diagnoses included non-Hodgkin’s lymphoma (n=37: 17 low grade and 20 intermediate grade), Hodgkin’s lymphoma (n=6), and multiple myeloma (n=4). Median number of chemotherapy cycles prior to harvest was 11 (range 5–20); 17 pts (36%) had previously received radiotherapy. 42 pts had 1 mobilization attempt and 5 pts had 2 attempts. Mobilization regimens included chemotherapy(C) + G-CSF (n=27), C + G-CSF + SCF (n=20), G-CSF + SCF (n=4) and C + GM-CSF (n=1). G-CSF was given at a minimum dose of 10μg/kg/day. Pts were defined as poor mobilizers if the peak value of CD34+ cells during mobilization was lower than 10 cells/μL (n=33) or in the case of stem cell collection, if less than 1 x 106 CD34+ cells/kg were obtained (n=14). Conditioning regimens included: BEAC (n=38), Cy-TBI (n=5), high dose Melphalan (n=3), and BEAM (n=1). Infused median numbers of nucleated BM cells, CFU-GM and CD34+ cells per kilogram were 3.5×108 (range 1.0–21.6), 7.33×104 (range 0.3–52.7), and 1.1×106 (range 0.3–2.3), respectively. 34 pts received G-CSF during their hospitalization (median 12 days; range 2–38). Following transplant, median times to achieve an ANC > 0.5×109/L and platelet count >20×109/L were 19 (range 10–42) and 24 days (range 9–233), respectively; median time to RBC transfusion independence was 33 days (range 1–425). Median time to hospital discharge was 25 days (range 14–64). With a median follow-up of 36 months (range 1–97), Kaplan-Meier estimates of overall and disease-free survival at 3 years are 67% and 44%, respectively. The Kaplan-Meier estimates of transfusion independence for platelets and RBC at 3 months are 86% and 84%, and at 1 year 97% and 95%, respectively. 2 pts (4.3%) experienced procedure related deaths prior to day +100, one of cardiac insufficiency on day +3 and one of septic shock on day +90. Cumulative incidences of non relapse mortality at 1, 3 and 5 years were 4.3%, 10.6% and 14.9%, respectively. The incidence of post transplant MDS/AML was 10.6%. Conclusion: Autologous transplant with unprimed BM graft after failed PBSC mobilization does not adversely affect engraftment or transplant related toxicity significantly. Thus, hard to mobilize patients should not be excluded from a potentially curative treatment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».