Bone marrow transplantation
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Bone Marrow Transplant. · Nov 1995
Clinical TrialA phase I trial of interleukin 3 (IL-3) pre-bone marrow harvest with granulocyte-macrophage colony-stimulating factor (GM-CSF) post-stem cell infusion in patients with solid tumors receiving high-dose combination chemotherapy.
In humans, interleukin 3 (IL-3) administration increases the cellularity and cycling of bone marrow progenitor cell populations. Initially, in primates and then in humans, IL-3 in sequence with GM-CSF has been shown to stimulate multilineage hematopoiesis. Based upon these effects, we designed a phase I trial of daily IL-3 administered subcutaneously for 10 days at dose levels of 2.5, 5.0, 10.0, 12.5, and 15.0 micrograms/kg followed within 72 h by bone marrow harvest, high-dose chemotherapy, and following chemotherapy, a fixed dose (5.0 micrograms/kg/day) of GM-CSF and bone marrow rescue. ⋯ When IL-3 dose levels were analyzed separately, engraftment of neutrophils and platelets, blood product (platelets and packed RBCs) utilization, and discharge date were not superior in those treated with the higher dose (15.0 micrograms/kg) of IL-3. While higher doses of IL-3 were associated with more toxicity, they did not appear to enhance the stem cell pool or speed engraftment later. The effects of pre-bone marrow harvest IL-3 are modest and likely not as impressive as other approaches aimed at enhancing hematologic recovery following high-dose chemotherapy.
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Patients undergoing a bone marrow harvest have traditionally been hospitalized for several days. Recently, the feasibility of outpatient bone marrow harvesting has been reported. We retrospectively examined the results of 485 patients undergoing an outpatient bone marrow harvest from 1989 to 1993. ⋯ After adjusting for volume harvested and time under anesthesia, harvest yield was higher in normal donors and patients with breast cancer than for patients with non-Hodgkin's lymphoma and Hodgkin's disease. We conclude that outpatient harvesting is safe. The negative correlation of time under anesthesia with harvest yield may be a result of variables which are difficult to quantify, such as bone marrow microenvironment.