Transcript Stem Cell Mobilization and Procurement

“Anyone can give up, it’s the easiest
thing in the world to do. But to hold it
together when everyone else would
understand if you fell apart, that’s true
strength”
• Sources of stem cells
• Case Report
– Mobilization schedule for autologous donor
Stem Cell Sources
• Bone Marrow Harvest (BM)
• Peripheral Blood Stem Cell (PBSC)
• Umbilical Cord Blood
Which is best?
• Multi-center study recently completed by
NMDP comparing PBSC to BM.
− # days to engraftment
– Amount of Graft Vs. Host disease (GVHD)
– Disease recurrence.
– Results pending
Who Decides?
• Decision regarding source:
– Related donors = physician decides (at our
center last year in adults 100% PBSC)
– Unrelated donors = physician requests
product but donor can decide to
accommodate that request or not.
Bone Marrow Harvest
• Used to be standard procedure for
harvesting stem cells
• Requires general anesthesia
• Multiple needle punctures into the Posterior
iliac crest to extract liquid bone marrow
• Amount harvested depends on size of
recipient, usually no more than 2% of donor
marrow.
• Used mostly with pediatric population rarely
for adult donors.
Umbilical Cord Blood
• Advantages:
– Rich source of haemopoeitic stem and
progenitor cells.
– Contains more naive T-cells than bone
marrow which allows for a greater mis- match
without increased risk of GVHD
– No risk to donors
– Decreased risk of infection
– Easily obtained
Umbilical Cord Blood
• Disadvantages
– Definitive number of cells. Can not
request more from donor
– Longer time to engraftment.
– Often time total cell count (TCN) not
enough for adult.
Obtaining Cord Blood
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Unsuccessful unrelated search.
Search Cord Blood Banks through the NMDP.
Often times request 2 cords to increase TNC.
Usually attempt to find 5/6 HLA match cords.
Cords shipped to our facility once patient is
ready for transplant, but before prep regimen is
started (if shipped and not used cannot be
returned and we incur expense)
Peripheral Blood Stem Cells
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Most frequent way for obtaining stem cells.
Does not require general anesthesis
Decrease risk to donor
Quicker time to engraftment than BM.
Related donors
• Initial visit to Bone Marrow Transplant
Clinic for testing to determine eligibility.
• Starting on Friday donor begins Growth
Colony Stimulating Factor (GCSF) 10
mcg/kg sub-q daily.
• Saturday and Sunday GCSF injection.
• Monday begin PBSC.
• Usually collect enough in one day,
sometimes requires another collection.
Medications
Growth Colony Stimulating Factor
• Most commonly used agent to mobilize
stem cells.
• Hormone that stimulates the bone marrow
to produce hematopoietic cells.
• Side Effects:
– Bone pain
– Headache
– Nausea
– Local reaction at injection site
Medications
Plerixafor
• Given with GCSF, binds with protein on the surface of
the stem cell disrupting the bond that normally keeps the
stem cell anchored in the bone marrow.
• .24 mg/kg sub-q at 9:00 PM
• Side effects – generally well tolerated.
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Diarrhea
nausea
tiredness,
Injection site reactions
Headache
Joint pain
dizziness
Schedule for ____________________
MR#________________.
Friday August 28th, 2009
In preparation for your catheter placement you will need to not eat or
drink after midnight.
Start: levaquin 500 mg tablet daily
bactrim DS 1 tablet daily
Continue both until admission for transplant.
Also start OTC tums 2 tabs 3X/day continue these until apheresis is complete.
9:00 AM Bone Marrow Transplant Clinic – North Hospital 7th floor
Neupogen injections
Levaquin, Tums, and Bactrim
10:00 AM Registration for Catheter Placment
Gateway Building 1st Floor
After you finish with regirstration you will be directed to Main
Hospital 3rd floor Radiology Department for the catheter placment
Saturday August 29th, 2009
10:00 AM Bone Marrow Transplant Clinic
North Hospital 7th floor
Neupogen injections
Levaquin, Tums and Bactrim
Sunday August 30th, 2009
10:00 AM Bone Marrow Transplant Clinic
Neupogen injections,
Levaquin, Tums, Bactrim
Monday August 31st, 2009
8:00 AM Bone Marrow Transplant Clinic –North Hospital 7th
floor
Neupogen injections
Levaquin, Tums, Bactrim
Following your injection this morning if your counts are adequate you will be directed
to the Apheresis Unit, Gateway Building 6th floor to begin the stem cell collection.
The labs take approximately 2 hours to result. If your counts are not adequate with
neupogen alone we will add **mozobil injection that evening. You will be advised of
your lab results and the plan. If you come back that night for mozobil Tuesday
morning you will go directly to the apheresis unit at 8:00 AM. Apheresis takes 3-5
hours. Please eat breakfast before the procedure. If you start mozobil these
injections will be continued each night along with apheresis the following morning
until we have collected an adequate number of cells for transplant.
9:00 PM North Hospital 10th floor
Inpatient Bone Marrow Transplant Unit
**Mozobil injection
Tuesday September 1st, 2009
8:00 AM Gateway 6 Apheresis Unit to begin
collecting stem cells
Lab work
Neupogen injections
Tums, Bactrim, and Levaquin
8:00PM North Hospital 10th floor
Inpatient Bone Marrow Transplant Unit
Mozobil injection
This will continue daily until we have
collected enough stem cells
Goals for collection
• Single Transplant 5 X 10(6) stem cells
• Tandem Transplant 10 X 10(6) stem cells
• This is counted daily at the end of
collection which will determine if the
patient continues with apheresis the next
day.
“To get through the
hardest journey we need
take only one step at a
time, but we must keep on
stepping”