Korean J Hematol.  2001 Feb;36(1):25-34.

Allogeneic Peripheral Blood Stem Cell Transplantation in Hematological Malignancies: Stem Cell Mobilization with GM-CSF alone or a combination of GM-CSF and G-CSF from Normal Healthy Donors

• Kwak DS
• Lee YT
• Chae YS
• Seo KW
• Park SW
• Baek JH
• Kim JG
• Kim DH
• Jung JT
• Park SH
• Sohn SK
• Suh JS
• Lee KB

Abstract

BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) has been used in normal heathy donors to mobilize hematopoietic progenitors. Recently, it was reported that an addition of granulocyte-macrophage-CSF (GM-CSF) mobilized more primitive CD34+ subsets than did G- CSF alone. We investigated the result of the allogeneic peripheral blood stem cell transplantation (PBSCT) with stem cells mobilized with GM-CSF alone or a combination of GM-CSF and G-CSF from normal healthy donors in hematological malignancies.
METHODS
Twenty-nine patients with hematologic malignancies had allogeneic PBSCT from normal sibling donors. Nine healthy donors were mobilized with GM-CSF (Leucogen (R)) alone and 20 with a combination of GM-CSF and G-CSF (Leucostim (R)). After 5~8 days of cytokine treatment, PBSCs were collected by large volume leukapheresis and analyzed.
RESULTS
Stem cells were collected from the HLA matched normal healthy sibling donors. The mean harvested cell content was 8.74+/-3.22X10(8) MNCs/kg, 15.65+/-16.02X10(6) CD34+ cells/kg of the patients. There were significant differences in the harvested MNC count between mobilization group with GM-CSF alone and group with a bination of GM-CSF and G-CSF. Observed side effects of cytokine mobilization were myalgia (76%), headache (41%), febrile sense (24%) and skin rash (10%). These complications disappeared within 48 hours after discontinuation of cytokines. The median interval to achieve a WBC count>500/uL was 15.00+/-4.23 days, and 14.00+/-33.01 days to a platelet count>20,000/uL. The actual incidence of acute GVHD was 36.4%, 22.7%, and 4.5% for skin, GIT, and liver, respectively. Immunosuppressant responsive chronic GVHD developed in 63.1% (12/19) of assessable patients including 6 cases who had donor lymphocyte infusions.
CONCLUSION
In this study, GM-CSF based cytokine mobilization was able to collect sufficient numbers of stem cells and allow rapid engraftment in the allogeneic PBSCT. Mobilization protocol with a combination of GM-CSF and G-CSF seemed to be superior to GM-CSF alone. Acute GVHD in patients with allogeneic PBSCT didn't appear to be more severe than in patients undergoing allogeneic BMT.

Keyword

Allogeneic PBSCT; GM-CSF; GVHD; Stem cell mobilization

MeSH Terms

Blood Platelets
Cytokines
Exanthema
Granulocyte Colony-Stimulating Factor*
Granulocyte-Macrophage Colony-Stimulating Factor*
Headache
Hematologic Neoplasms*
Hematopoietic Stem Cell Mobilization*
Humans
Incidence
Leukapheresis
Liver
Lymphocytes
Myalgia
Peripheral Blood Stem Cell Transplantation*
Siblings
Skin
Stem Cells*
Tissue Donors*
Cytokines
Granulocyte Colony-Stimulating Factor
Granulocyte-Macrophage Colony-Stimulating Factor