Complete and Fast Hematologic Reconstitution with Non-Cryopreserved Stem Cell after a 5 Days BEAM Conditioning and Autologous Stem Cell Transplantation.

There are several reports published in the medical literature addressing the roll of non-cryopreserved stem cells for supporting autologous transplant in lymphoma patients. However, in most of them, the conditioning used was a modification of BEAM or CBV with important differences in dose intensity or, in fact with different drugs. We present our experience using non cryopreseved stem cells and BEAM, but without decreasing the dose intensity of it. From Jun 2004 to May 2007, after a signed inform consent, 20 patients were transplanted; 16 men, 4 women, the median age was 37 years (range 15–57), 9 with Hodgkin lymphoma, 10 with large cell lymphoma and 1 with Burkitt. 13 of them were in second complete remission and 7 in third or partial remission. The mobilization was done with filgrastin 5 mg/kg/BID without chemotherapy and in the 5^th and 6^th day a leukopheresis of 3 or 4 blood volume was performed, the cells obtained were stored at 4oC for 6 days, in the case of the first leukopheresis, and for 5 days in the case of the second leukopheresis The administration of BEAM began in the evening of the last leukopheresis day and it was completed in 5 days as follow: BiCNU 300 mgs/m2 on day −5, etoposide 150–200 mgs/m2 BID for 6 doses on days −5 to −2, citarabine 300–400 mgs/m2 /day from days −4 to −2 and melphalam 140/mg/m2 on day −2. The stem cells were re-infused on day zero after 6 days of refrigeration for the first leokopheresis, and 5 days for the second. All patients received filgrastin from day + 5 until neutrophil recovery or pegfilgrastin one dose The mobilization and recollection were successful in 19 out of 20 patients with a median CD34 of 2.3 x 10(6)/kg (range 1–6) but in one was necessary obtain also bone marrow stem cell. The median viability of the cells after 6 days of refrigeration, measured by trypan blue, was 82% (range 66–90). The median time to achieve an absolute neutrophil count greater than 500 /ml in all patients was 12 days (range 9–20); 18 out of 20 were evaluable for thrombopoesis, they obtained a self sustained platelets count of 20.000 or more at a median of 15 days (range 9–30). The tolerance of the 5 days BEAM was good, one patient died from weak capillary syndrome on day + 18 and another from pneumonia on day + 16 there were no other grade III or IV non hematologic toxicity. With a follow of 3 to 36 months 13 out of 20 patients are alive. We conclude that the use of non-cryopreserved stem cell for supporting autologous transplant after a 5 days BEAM conditioning is feasible, safe, and produce a rapid, complete and sustained hematopoiesis. This simple procedure is a good alternative for saving costs.