transfusion requirements in autologous stem cell transplantation: a single-center-experience
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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. - PowerPoint PPT PresentationTRANSCRIPT
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