J Korean Med Sci.  2013 Feb;28(2):220-226. 10.3346/jkms.2013.28.2.220.

Hematologic Recovery after Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors

• Son MH
• Kim DH
• Lee SH
• Yoo KH
• Sung KW
• Koo HH
• Kim JY
• Cho EJ
• Kang ES
• Kim DW

• KMID: 1429184
• DOI: http://doi.org/10.3346/jkms.2013.28.2.220

Abstract

Although the number of studies using tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) for the treatment of high-risk pediatric solid tumors has been increasing, documentation of hematologic recovery after tandem HDCT/autoSCT is very limited. For this reason, we retrospectively analyzed the hematologic recovery of 236 children with high-risk solid tumors who underwent tandem HDCT/autoSCT. The median numbers of CD34+ cells transplanted during the first and second HDCT/autoSCT were 4.3 x 10(6)/kg (range 0.6-220.2) and 4.1 x 10(6)/kg (range 0.9-157.6), respectively (P = 0.664). While there was no difference in neutrophil recovery between the first and second HDCT/autoSCT, platelet and RBC recoveries were significantly delayed in the second HDCT/autoSCT (P < 0.001 and P < 0.001, respectively). Delayed recovery in the second HDCT/autoSCT was more prominent when the number of transplanted CD34+ cells was lower, especially if it was < 2 x 10(6)/kg. A lower CD34+ cell count was also associated with increased RBC transfusion requirements and a higher serum ferritin level after tandem HDCT/autoSCT. More CD34+ cells need to be transplanted during the second HDCT/autoSCT in order to achieve the same hematologic recovery as the first HDCT/autoSCT.

Keyword

High-Dose Chemotherapy; Autologous Stem Cell Transplantation; CD34+ Cells; Hematologic Recovery; Iron Overload

MeSH Terms

Adolescent
Antigens, CD34/metabolism
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Blood Cell Count
Blood Platelets/cytology
Child
Child, Preschool
Combined Modality Therapy
Erythrocytes/cytology
Female
Ferritins/blood
Humans
Infant
Male
Neoplasms/*drug therapy
Neutrophils/cytology
Retrospective Studies
*Stem Cell Transplantation
Stem Cells/cytology/metabolism
Transplantation, Autologous
Young Adult
Antigens, CD34
Ferritins

Figure

• 

  Fig. 1 Hematologic recovery based on the number of transplanted CD34+ cells. There are no differences in neutrophil recovery between the first and second HDCT/autoSCT (A-D). However, platelet recovery (E-H) and RBC recovery (I-L) are significantly delayed in the second HDCT/autoSCT compared to the first HDCT/autoSCT. The delays in the platelet and RBC recoveries after the second HDCT/autoSCT are more prominent when the number of transplanted CD34+ cells was lower, particularly if it was < 2 × 106/kg (H and L).

• 

  Fig. 2 RBC transfusion amount (mL/kg) and serum ferritin level (ng/mL) after the second HDCT/autoSCT based on the number of transplanted CD34+ cells. (A) The RBC transfusion amount during the first year after the second HDCT/autoSCT is higher when the number of transplanted CD34+ cells was lower, particularly if it was < 2 × 106/kg. (B) The serum ferritin level one year after the second HDCT/autoSCT is higher when the number of CD34+ cells transplanted in the second HDCT/autoSCT was lower.

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