Collection and Transplantation of Autologous Peripheral Blood Stem Cells in Adults(Symposium 4: Peripheral Blood Stem Cell Apheresis)

概要

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Autologous peripheral blood stem cell transplantation (PBSCT) is currently replacing autologous bone marrow transplantation for the therapy of malignant diseases because of rapid hematopoietic recovery after transplantation. A sufficient number of PBSCs for rapid engraftment can be effectively mobilized by administration of granulocyte colony-stimulating factor following chemotherapy. The optimal timing of collection is guided by observing trilineage hematopoietic recovery as well as measuring CD34+ cells in peripheral blood. Although the technical problems of PBSCs collection have been solved, the possible indication of PBSCT for acute leukemia is controversial. We performed autologous PBSCT on 55 acute myelogenous leukemia (AML) patients and 26 acute lymphoblastic leukemia (ALL) patients. In the AML patients, G-CSF was combined with the conditioning regimen to augment the anti-leukemic effect. The estimated three-year event-free survival (EFS) of 39 AML patients at first remission (CR) was 58%, which was comparable to that of allogeneic BMT. For the ALL patients, on the contrary, 3-year EFS was 37% at first CR. The high incidence of leukemic relapse was a major problem. From our observations, PBSCT can be used as the treatment of choice for AML. However, improvements in the therapeutic strategy is essential in PBSCT for the treatment of ALL.
日本アフェレシス学会の論文