Determine safety of outpatient chemotherapy and autotransplants using refrigerated, non‐frozen grafts in persons with multiple sclerosis
| Autor: | Alejandro Ruiz-Argüelles, David Gómez-Almaguer, Juan Carlos Olivares-Gazca, Andrés Gómez-De-León, María José Muñoz-Pérez, Andrés A. León-Peña, Elena Soto-Vega, Guillermo J. Ruiz-Argüelles, Robert Peter Gale, Gisela B. Gomez-Cruz, Elias Eugenio Gonzalez-Lopez, Guillermo J. Ruiz-Delgado |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Multiple Sclerosis Filgrastim Cyclophosphamide medicine.medical_treatment 030230 surgery Blood cell Young Adult 03 medical and health sciences 0302 clinical medicine Hematologic Agents Outpatients medicine Humans Platelet Autografts Aged Transplantation Chemotherapy business.industry Multiple sclerosis Hematopoietic Stem Cell Transplantation Middle Aged Myeloablative Agonists Prognosis medicine.disease Combined Modality Therapy Surgery medicine.anatomical_structure Outpatient chemotherapy Blood Preservation Female 030211 gastroenterology & hepatology Rituximab Patient Safety business Follow-Up Studies medicine.drug |
| Zdroj: | Clinical Transplantation. 33 |
| ISSN: | 1399-0012 0902-0063 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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