Successful Peripheral Haematopoitic Autologous Stem Cells Transplants After More Than 5 Days of without Cryopreservation In Non Hodgkin Lymphoma: Asian Scenario

Methods to simplify the stem cell transplantation procedure are the need of the hour in developing countries due to constraints of affordability and the large number of eligible patient for transplantation. Unprocessed leukapheresed material is useful to restore hemopoiesis after high dose chemotherapy and, in addition to being significantly less expensive, it also avoids the toxicity of cryopreservation (DMSO).

Over a period of 18 months (January 2009 to June 2010) in a hospital setting, we prospectively performed auto transplants in 5 relapsed/resistant non-Hodgkin's lymphoma patients using non-cryopreserved (stored for 5–8 days at 4°C) and un-manipulated peripheral blood stem cells mobilized by GCSF (10mg/kg/day) and GMCSF (5mg/kg/day) using a 5–7 day conditioning regimen. Viability of stem cells was checked daily by trypen blue and the cell were reinfused cells when viability comes down to less then 80% (minimum 5 days) or on day 8 which ever was earlier. The median collection of CD34⁺ stem cells was 2.8 × 10⁶/cu mm (range 2–4.8 × 10 ⁶/cumm)

The median time to achieve > 0.5 × 10⁹/l granulocytes was 14 days. The median time to achieve > 20 × 10⁹/l platelets was 16 days. CR was achieved in 4 cases. A very good partial response was achieved in 1 case. The 100-day mortality was zero. One patient, who was not in CR, died from relapse of the lymphoma, 9 months post transplant. The overall median post-transplant survival for other patients has not been reached. The approximate cost of the each graft was US$6,000.

From this small series, we conclude that a simplified method to autograft patients avoiding purging procedures and cryopreservation of the cells is feasible. This technique helps avoid toxicity of DMSO and significantly decreases the cost of autologous hematopoietic stem cell transplant, perhaps in the world, an important issue in developing countries.

No relevant conflicts of interest to declare.