Akademik Veri Yönetim Sistemi
Bone Marrow Transplantation, cilt.15, sa.6, ss.907-913, 1995 (SCI-Expanded)
This retrospective study was conducted to determine whether the total number of nucleated cells (TNC)/kg collected at marrow harvest was associated with outcome in 151 patients with acute myelogenous leukemia (AML) who received an autologous purged (n = 67) or non-purged (n = 84) marrow transplant. At the time of transplant 33 patients were in first complete remission (CR), 47 in second CR, 54 in first relapse and 17 beyond second CR. Ninety patients received busulfan (BU) 16 mg/kg and cyclophosphamide (CY) 120 or 200 mg/kg, 51 patients received CY 120 mg/kg and total body irradiation (TBI) 12-15.75 Gy and 10 patients received BU 8 mg/kg, CY 60 mg/kg and TBI 12 Gy as conditioning regimens. Patients whose marrow harvest yielded <2 x 108 TNC/kg did not undergo purging with 4-hydroperoxycyclophosphamide (4HC). This group of patients (n = 28) had a 100 day mortality of 50% and only 54% achieved a granulocyte levels of >0.5 x 109/l and 29% achieved platelet transfusion independence. Patients whose marrow harvest yielded 2-4 x 108 TNC/kg and did not undergo marrow purging had a 20% mortality by day 100, 91% recovered granulocytes to >0.5 x 109/l and 61% became platelet independent. Patients whose marrow harvest yielded 2-4 x 108 TNC/kg and underwent marrow purging with 4HC had a 50% mortality by day 100 and 58% achieved a granulocyte levels of >0.5 x 109/l and 42% became platelet transfusion independent. Patients whose marrow yielded >4 x 108 TNC/kg and underwent marrow purging with 4HC had a 35% mortality by day 100 and 79% achieved a granulocyte levels of >0.5 x 109/l and 51% became platelet independent. In a multivariate analysis, non-purged cell doses of 2-4 x 108 TNC/kg were significantly associated with a decreased 100-day mortality compared with a dose of <2 x 108 TNC/kg (P = 0.005) after adjusting for disease status and patient age at transplant. Purged cell doses of 2-4 and >4 x 108 TNC/kg were not significantly different from the non-purged dose of <2 x 108 TNC/kg in terms of 100-day mortality (P = 0.75 and 0.14, respectively). Engraftment of granulocytes and platelets was delayed in patients receiving <2 x 108 TNC/kg or purged marrows compared with patients receiving non-purged 2-4 x 108 TNC/kg. Increasing cell dose in both purged and non-purged groups was significantly associated with improved EFS. This study also suggests that patients in whom <2 x 108 TNC/kg is harvested probably should not be transplanted using autologous marrow alone.