1.
Frontline-matched sibling donor transplant of aplastic anemia patients using primed versus steady-state bone marrow grafts
El Fakih, R., Alfraih, F., Alhayli, S., Ahmed, S. O., Shaheen, M., Chaudhri, N., Alsharif, F., Hanbali, A., Alshaibani, A., Alotaibi, A. S., et al
Annals of hematology. 2021
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Editor's Choice
Abstract
Priming donors with G-CSF before BM harvest is reported to improve engraftment and GvHD in recipients. These effects are highly desirable when transplanting patients with non-neoplastic hematologic diseases, particularly AA patients. Here we retrospectively report the outcomes of 39 AA patients receiving a primed BM graft from MSD to 43 patients receiving a steady-state BM graft from MSD, otherwise transplanted using a uniform transplant platform. The graft had higher TNC and CD34 cell concentrations in the primed group (p?0.001), and that was reflected in higher TNC and CD34 doses per kilogram of recipient in the primed group (p?=?0.004 and 0.03, respectively). The OS for primed BM graft recipients was 97.4% and 78.9% for the steady-state BM graft recipients, p-value?=?0.01. The cumulative incidence of death without GF was 2.6% in the primed group and 16.3% in the steady-state group, p-value?=?0.03. There was no difference in GvHD incidence between the two groups. We confirm that priming improved the TNC and CD34 graft concentration and cell dose; this evidence along with other reported studies constitute reasonable evidence to prove that BM priming improve engraftment. We observed no increase in GvHD using primed BM graft.
PICO Summary
Population
Patients with aplastic anaemia, undergoing matched sibling donor transplant (n=82)
Intervention
Bone marrow (BM) graft primed with G-CSF before bone marrow harvest (n=39)
Comparison
Steady state BM graft (n=43)
Outcome
The graft had higher TNC and CD34 cell concentrations in the primed group, and that was reflected in higher TNC and CD34 doses per kilogram of recipient in the primed group. The overall survival for primed BM graft recipients was 97.4% and 78.9% for the steady-state BM graft recipients. The cumulative incidence of death without graft failure was 2.6% in the primed group and 16.3% in the steady-state group. There was no difference in GvHD incidence between the two groups.
2.
Granulocyte Colony-Stimulating Factor is Safe and Well Tolerated following Allogeneic Transplantation in Patients with Sickle Cell Disease
Shah, N. C., Bhoopatiraju, S., Abraham, A., Anderson, E., Andreansky, M., Bhatia, M., Chaudhury, S., Cuvelier, G. D. E., Godder, K., Grimley, M., et al
Transplantation and cellular therapy. 2021
Abstract
Granulocyte colony-stimulating factor (G-CSF) used after hematopoietic stem cell transplantation (HSCT) can enhance neutrophil recovery in patients rendered neutropenic by the preparative regimen. G-CSF is contraindicated in patients with sickle cell disease (SCD) as life-threatening complications can ensue in the presence of sickle vasculopathy. However, the safety profile of G-CSF after HSCT for SCD has not been previously described. We report clinical outcomes in the first 100 days post-HSCT in patients supported with G-CSF until neutrophil recovery on a clinical trial of reduced intensity transplantation for SCD. Patients (n=62) received G-CSF for a median of 9 days (range, 5-33) following transplant from the best available stem cell source. Preparation for transplant included a target hemoglobin S level of ≤45%. Neutrophil engraftment (ANC >0.5 × 10(3)/mL) was achieved at a median of 13 days (range,10-34) and platelet engraftment (>50 × 10(3)/mL) at a median of 19 days (range, 12-71). The median duration of inpatient hospitalization following stem cell infusion (day 0) was 21.5 days (range 11-33). No patient developed SCD related complications following G-CSF use. The most common organ toxicities encountered between G-CSF commencement (on day +7) and day +100 were anorexia (14), hypertension (11) and electrolyte imbalance requiring correction (9). Central nervous system related events were noted in 5 patients, all with pre-existing cerebral vasculopathy/moyamoya disease and attributed to reversible posterior leukoencephalopathy syndrome (RPLS) in the presence of calcineurin inhibitor therapy and hypertension. We conclude that G-CSF does not adversely impact SCD transplant recipients and can be safely used post-HSCT to enhance neutrophil recovery.