RAPID ENGRAFTMENT AFTER AUTOLOGOUS TRANSPLANTATION UTILIZING MARROW AND RECOMBINANT GRANULOCYTE-COLONY-STIMULATING FACTOR-MOBILIZED PERIPHERAL-BLOOD STEM-CELLS IN PATIENTS WITH ACUTE MYELOGENOUS LEUKEMIA

This study was performed to determine whether peripheral blood stem cells (PBSCs) mobilized with recombinant granulocyte-colony stimulating factor (rhG-CSF) increase the tempo of granulocyte and platelet recovery when added to marrow in patients with acute myelogenous leukemia (AML) undergoing autologous bone marrow transplantation (BMT), Twenty six patients with AML had bone marrow harvested in first (n = 16) or second (n = 10) complete remission (CR) and cryopreserved. Patients received rhG-CSF alone (n = 20) or rhG-CSF following chemotherapy (n = 6). PBSCs were collected from 24 of the 26 patients a median of 7 (range 3-2130) days after marrow harvest. Two patients presumed to be in second CR did not have PBSCs collected because of early relapse. Fourteen patients in first CR (n = 3), second CR (n = 8) or first relapse (n = 3) proceeded to autologous BMT utilizing marrow + rhG-CSF-mobilized PBSCs, Engraftment parameters were compared with a historical group of 158 patients with AML who had received purged (n = 67) or unpurged (n = 91) autologous BMT without PBSCs, The median number of peripheral blood total nucleated and CD34(+) cells collected from 24 patients was 19.55 x 10(8)/kg (range 1.83 -54.83) and 5.59 x 10(6)/kg (1.23-34.79), respectively. All patients transplanted achieved a granulocyte level of >0.5 x 10(9)/l with a median of 13 days (range 11-27 days) and platelets to 20 x 10(9)/l median 14 days (range 9-83 days), Seventy three of 91 historical patients receiving unpurged marrow alone achieved a granulocyte level of 0.5 x 10(9)/l with a median of 30 days (range 11-106 days) while 46 of 91 achieved platelets >20 x 10(9)/l with a median of 40 days (range 9-131 days), Patients with AML receiving marrow and rhG-CSF-mobilized PBSCs had earlier engraftment than was previously observed using purged or unpurged marrow, Further studies are needed to determine if the inclusion of marrow is necessary for prompt and sustained engraftment, These data are too limited to draw conclusions about the incidence of leukemic relapse after the administration of rhG-CSF.