ENGRAFTMENT OF PATIENTS WITH LYMPHOID MALIGNANCIES TRANSPLANTED WITH AUTOLOGOUS BONE-MARROW, PERIPHERAL-BLOOD STEM-CELLS OR BOTH

Forty six patients with lymphoid malignancies receiving autologous transplants using three different sources of hematopoietic stem cells were compared for engraftment parameters. Thirteen patients (five with multiple myeloma, seven with non-Hodgkin's lymphoma and one with Hodgkin's lymphoma) received autologous marrow with post-transplant growth factors (group 1). During the same time interval, 14 patients (five with multiple myeloma, six with non-Hodgkin's lymphoma and three with Hodgkin's lymphoma) were transplanted with autologous marrow plus recombinant granulocyte colony-stimulating factor (rhG-CSF)-mobilized peripheral blood stem cells (PBSC) and post-transplant growth factors (group 2). Nineteen patients (seven with multiple myeloma and 12 with non-Hodgkin's lymphoma) received rhG-CSF mobilized PBSC and post-transplant growth factors (group 3). All PBSC were collected after G-CSF mobilization (16 mu g/kg/day s.c. for 6 days) without prior chemotherapy. After high-dose myeloablative chemotherapy or chemoradiotherapy, the median days to recovery of neutrophils to levels of 0.5 and 1.0 x 10(9)/I were 12 vs. 9 vs. 9 days (P = 0.0003 (group 1 vs. group 2) and P = 0.53 (group 2 vs, group 3)) and 13 vs. 10 vs. 10 days (P = 0.0003 (group 1 vs. group 2) and 0.92 (group 2 vs. group 3)) for groups 1, 2 and 3, respectively. The median day to platelet transfusion independence was 22 vs. 11 vs. 11 days (P = 0.001 (group 1 vs. group 2) and P = 0.50 (group 2 vs. group 3)) for groups 1, 2 and 3, respectively. The median number of units of platelets transfused was 119 vs, 39 vs, 40 (P = 0.0236 (group 1 vs. group 2) and P = 0.83 (group 2 vs, group 3)) for groups 1, 2 and 3, respectively. No secondary graft failures were observed in any patient. These data demonstrate that G-CSF mobilized peripheral blood stem cells are effective in reducing the time of neutropenia, platelet dependency and days on antibiotics in heavily pre-treated patients with lymphoid malignancies. PBSC alone appears to be superior to marrow alone for engraftment and the addition of marrow appears to be unnecessary.