transfusion requirements in autologous stem cell transplantation: a single-center-experience

Transfusion requirements in autologous stem cell

transplantation: a single-center-

experience

Sousse 26 05 2012

INTRODUCTION

The transfusion support in peripheral blood stem cell transplantation is critical to the outcome of patients.

Aim of this study : evaluate the transfusion requirements in autologous stem cell transplantation.

METHODS

retrospective study

30 patients/ Lymphoma

Autologous peripheral blood stem cell transplantations

2010-2011

PATHOLOGY

Median age :30 years (range: 16-59).

sex ratio=2: 20 Males (67%) 10 Females (33%)

CONDITIONING REGIMEN : (BEAM)

Carmustine (BCNU):300mg/m² at the day(-7) Etoposide: 200 mg/m² from day(-6) to day(-3) Cytarabine:200mg/m² twice a day ,from day (-

6) to day(-3) Melphalan:140mg/m² at the day (-2)

G-CSF (5ug/kg/day): From day 5 to neutrophils recovery

(>1000/mm3)

Graft : 5,83 x10⁶ CD34/kg (range: 3- 14,95)

median duration of chemotherapy –induced aplasia : 10 days (range 7-40).

TRANSFUSION INDICATIONS

Red Blood cell units: Hemoglobin level <8g/dl Poorly tolerated anemia

Platelet concentrates: Platelet count <20.000 bleeding

Total Blood products transfusion

39 packed red blood cell units

47 apheresis platelet concentrates

16 standard platelet transfusions: 99 SPC

RED BLOOD CELL TRANSFUSION

Median delay for red blood cell transfusion:

5 days after autograft (2 -9)

15 patients (50%) median number of transfused

packed red blood cell units per patient : 2 (1-10).

median hemoglobin level before RBC transfusion :

6,8 g/dl (range 5,4 -8,7)

RED BLOOD CELL TRANSFUSION

No RBC transfusions : 50 % Median age : 30 years (range: 16- 59) Sex: 12 males, 3 females Pathology: 12 non Hodgkin lymphoma

(2B) 3 Hodgkin lymphoma Graft : median of 5,79 x 10⁶ CD34/kg

(range:3,6-14,45) No difference in CD 34 + with

transfused group

RED BLOOD CELL TRANSFUSION

PLATELET CONCENTRATES TRANSFUSION

29 patients (96.6%)

Delay for PC transfusion: 6 days after autograft (2-6)

Number of platelet transfusion sessions per patient : 2 (1-8).

Platelet count before platelet transfusion: 8000 (2000-26000)

One patient wasn’t transfused at all.

Age: 30 years

Sex: M

B- Cell lymphoma (CR1)

Graft: 9,16x 10⁶ CD34+/kg Duration of aplasia: 10 days

Transfusion free auto stem cell transplantation

DISCUSSION

• Transfusion requirements during autologous stem cell transplantation are not very important.

• In our patients : no influencing factors

• Littérature :• young age • number of CD34 infused +++

CD 34 +++ ≥ 5x 10⁶ /kg of CD34+ cells shortens hematopoietic

recovery

reduces the platelet transfusion requirements.

thrombopenia at the initiation of autologous transplantation is associated with increased platelet transfusion requirements independent of the dose of CD34+ cells infused

IL 11 : cytokine - stimulates hematopoietic stem cells,

and MGC - increases the speed of platelet

recovery -reduces platelet transfusions in

autologous stem cell transplantation no clinical benefit !!!• TPO, IL 6 regulate, stimulate

thrombopoiesis• IL 11 : interest ?? Cost???

Erythropoietin prevents apoptosis of late erythroid progenitos and proerythroblasts

No interest when level of endogenous Epo is high

Early :No benefit of Epo : not enough erythroid precursos to respond !!!

>Day 28 : Epo is very efficient Cost ???

Immature (or reticulated) platelets (PLTs) contain more RNA than mature PLTs

reflect the rate of thrombopoiesis.

Immature PLTs are more active because of their higher nucleic acid content and higher expression of P-selectin and glycoprotein.

efficacy of transfusion with rich IPF was higher than that oflow IPF transfusion

CONCLUSION Transfusion requirements in autologous

stem cell transplantation are not important.

CD34+ cells ≥ 5x 10⁶ /kg

No confirmed in our studyLarger series +++

Interest of Transfusion-free autograft in our context ?

Thanks for attention