Determine safety of outpatient chemotherapy and autotransplants using refrigerated, non-frozen grafts in persons with multiple sclerosis.

Autor: Gale RP; Imperial College London, London, UK., Gómez-Cruz GB; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Benemérita Universidad Autónoma de Puebla, Puebla, México., Olivares-Gazca JC; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Universidad Popular Autónoma del Estado de Puebla, Puebla, México., León-Peña AA; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Benemérita Universidad Autónoma de Puebla, Puebla, México., Gómez-Almaguer D; Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, México., Gómez-De-León A; Hospital Universitario de la Universidad Autónoma de Nuevo León, Monterrey, México., González-López EE; Universidad Popular Autónoma del Estado de Puebla, Puebla, México., Ruiz-Argüelles A; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Universidad Popular Autónoma del Estado de Puebla, Puebla, México.; Laboratorios Ruiz, Puebla, México., Soto-Vega E; Universidad Anáhuac, Puebla, México., Muñoz-Pérez MJ; Universidad Anáhuac, Puebla, México., Ruiz-Delgado GJ; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Universidad Popular Autónoma del Estado de Puebla, Puebla, México.; Laboratorios Ruiz, Puebla, México., Ruiz-Argüelles GJ; Centro de Hematología y Medicina Interna de Puebla, Puebla, México.; Universidad Popular Autónoma del Estado de Puebla, Puebla, México.; Laboratorios Ruiz, Puebla, México.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2019 Jun; Vol. 33 (6), pp. e13567. Date of Electronic Publication: 2019 May 07.
DOI: 10.1111/ctr.13567
Abstrakt: Background: Persons with multiple sclerosis are increasingly treated with intermediate- or high-dose chemotherapy and a hematopoietic cell autotransplant. This is often done in an inpatient setting using frozen blood cell grafts.
Objective: Determine if chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using refrigerated, non-frozen grafts.
Methods: We developed an autotransplant protocol actionable in an outpatient setting using a refrigerated, non-frozen blood graft collected after giving cyclophosphamide, 50 mg/kg/d × 2 days and filgrastim, 10 μg/kg/d. A second identical course was given 9 days later followed by infusion of blood cells stored at 4°C for 1-4 days. The co-primary outcomes were rates of granulocyte and platelet recovery and therapy-related mortality.
Results: We treated 426 consecutive subjects. Median age was 47 years (range, 21-68 years). A total of 145 (34%) were male. Median graft refrigeration time was 1 day (range, 1-4 days). Median interval to granulocytes >0.5 × 10E + 9/L was 8 days (range, 2-12) and to platelets >20 × 10E + 9/L, 8 days (range, 1-12). Only 15 subjects (4%) were hospitalized, predominately for iatrogenic pneumothorax (N = 5) and neutropenic fever (N = 4). There was only 1 early death from infection.
Conclusion: Intermediate-dose chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using, refrigerated, non-frozen grafts.
(© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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