Kriegsmann Katharina, Pavel Petra, Bochtler Tilmann, Schmitt Anita, Sauer Sandra, Kriegsmann Mark, Bruckner Thomas, Klein Stefan, Klüter Harald, Müller-Tidow Carsten, Wuchter Patrick
Department of Hematology, Oncology, and Rheumatology, Heidelberg University, Heidelberg, Germany.
Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany.
Transfus Med Hemother. 2021 Mar;48(2):91-98. doi: 10.1159/000509945. Epub 2020 Sep 15.
Recently, we identified a huge discrepancy between the collection practice and the actual utilization of cryopreserved peripheral blood stem cells (PBSCs) for high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ABSCT). Specifically, patients with Burkitt lymphoma, acute leukemia, and myeloproliferative neoplasms (MPN) were frequently not referred for ABSCT after successful PBSC collection.
The aim of this study was to identify variables that are associated with the non-utilization of PBSC grafts.
We retrospectively analyzed the collection, storage, and disposal of PBSC grafts in Burkitt lymphoma ( = 18), acute lymphoblastic leukemia (ALL, = 22), MPN ( = 18), and acute myeloid leukemia (AML, = 71) patients. Patients who underwent autologous PBSC collection at 2 collection and transplantation centers between 2001 and 2012 were included and followed up until 2016.
None of the Burkitt lymphoma patients were referred for ABSCT. Only in 1 (6%) patient, the graft was discarded after the patient's death. In all other patients ( = 17, 94%), the grafts were stored independently of the patient's status (death, = 4, 22%; no follow-up, = 6, 33%; no indication for ABSCT given, = 7, 39%). In ALL patients, 4 (18%) patients underwent ABSCT after a median follow-up of 74 (1-182) months. In the remaining patients, PBSC grafts were either discarded (8 patients, 36%) or stored until the reference date (10 patients, 45%). Seven of 18 MPN patients (39%) underwent ABSCT. ABSCT was performed in 24 (34%) AML patients. In 20 (28%) patients who were not referred to ABSCT, an allogeneic transplantation (TPL) was performed. Fifteen (21%) patients received palliative care or deceased, and their grafts were discarded in all but 1 patient. Additional grafts were discarded in 21 (31%) patients and stored in 9 (13%) patients who underwent ABSCT or allogeneic TPL ( = 44).
As the role and efficacy of autologous HDCT/ABSCT are not established in the analyzed entities, the indication for PBSC collection should be reanalyzed in regular intervals. Moreover, PBSC grafts from patients who have deceased, have insufficient grafts, or have already undergone an allogeneic TPL should be considered for disposal or (if applicable) for research use, to economize storage costs on a rational basis.
最近，我们发现冷冻保存的外周血干细胞（PBSC）用于高剂量化疗（HDCT）和自体造血干细胞移植（ABSCT）的采集实践与实际利用之间存在巨大差异。具体而言，伯基特淋巴瘤、急性白血病和骨髓增殖性肿瘤（MPN）患者在成功采集PBSC后，经常未被转诊进行ABSCT。
本研究的目的是确定与未使用PBSC移植物相关的变量。
我们回顾性分析了伯基特淋巴瘤（n = 18）、急性淋巴细胞白血病（ALL，n = 22）、MPN（n = 18）和急性髓细胞白血病（AML，n = 71）患者PBSC移植物的采集、储存和处置情况。纳入2001年至2012年期间在2个采集和移植中心接受自体PBSC采集的患者，并随访至2016年。
所有伯基特淋巴瘤患者均未被转诊进行ABSCT。仅1例（6%）患者在死亡后移植物被丢弃。在所有其他患者（n = 17，94%）中，移植物的储存与患者状态无关（死亡，n = 4，22%；无随访，n = 6，33%；未给出ABSCT指征，n = 7，39%）。在ALL患者中，4例（18%）患者在中位随访74（1 - 182）个月后接受了ABSCT。在其余患者中，PBSC移植物要么被丢弃（8例患者，36%），要么储存至参考日期（10例患者，45%）。18例MPN患者中有7例（39%）接受了ABSCT。24例（34%）AML患者接受了ABSCT。在20例（28%）未被转诊进行ABSCT的患者中，进行了异基因移植（TPL）。15例（21%）患者接受了姑息治疗或死亡，除1例患者外，他们的移植物均被丢弃。另外21例（31%）患者的移植物被丢弃，9例（13%）接受ABSCT或异基因TPL（n = 44）的患者的移植物被储存。
由于自体HDCT/ABSCT在分析的疾病实体中的作用和疗效尚未确立，应定期重新分析PBSC采集的指征。此外，对于已死亡、移植物不足或已接受异基因TPL的患者的PBSC移植物，应考虑进行处置或（如适用）用于研究，以合理节约储存成本。
