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BACKGROUND Extracorporeal photopheresis (ECP) is a recognized second-line treatment for steroid-refractory chronic graft-versus-host disease (cGVHD). Treatment course is usually long, expensive, and demanding for patients, so predictors for response are needed. We carried out a retrospective study on cGVHD patients treated at our institution with the aim to identify a possible correlation between apheretic yields composition and probability of response. STUDY DESIGN Patients treated for at least 6 months were eligible for the study. Flow cytometry data, including absolute counts of lymphocytes and their subpopulations in ECP products from cGVHD patients, were collected. For each cell population 1) the median dose per procedure harvested during the first 3 months of treatment and 2) the cumulative dose collected in the same period were compared with clinical response. RESULTS A total of 726 ECP procedures were performed in 15 patients. Overall response, defined as either a complete response (CR) or a partial response according to National Institutes of Health criteria, was obtained in 10 of 15 patients (66.7%), and CR, in eight of 15 (53.3%). According to Cox regression analysis, the probability of achieving an overall response is significantly correlated with the median number of CD3+, CD3+CD4+, and CD3+CD8+ lymphocytes collected during the early treatment phase (first 3 months). CONCLUSION Our data suggest that CD3+ cell evaluation in ECP during the early phase of treatment course could predict response and help identify patients who deserve further treatment.

Background Peripheral blood (PB) hematopoietic progenitor cells (HPC) collected by apheresis are the first-choice source for allogeneic stem cell transplantation. The target HPC dose is usually considered to be 4 × 106 CD34+ cells/kg of the recipient, but higher doses are required in reduced-intensity conditioning and haploidentical transplants. Thus, prolonged stimulation and repeated collections or failure to reach HPC target may occur, increasing risks for donors and recipients. We carried out a retrospective multicenter study on healthy donors, to identify donor variables which may correlate with HPC mobilization. Study Design and Methods HPC allogeneic donations from sibling and unrelated donors performed in two centers from 1995 to 2012 were analyzed. We defined a mobilization cutoff of 50 × 10 6 CD34+ cells/L and tested somatic variables, blood counts, and granulocyte-colony-stimulating factor (G-CSF) dose and molecular form. Results A total of 360 donors were analyzed (male, 201; female, 159; sibling, 348; unrelated, 12; median [range] age, 44.8 [13-80] years). Median peak CD34+ in PB was 54.4 × 106/L (range, 5 × 106-299 × 106). By multivariate analysis, we identified the following variables to correlate with good mobilization: 1) male sex (p < 0.0005); 2) younger age (p = 0.007); 3) higher baseline (premobilization) white blood cell (WBC) count (p < 0.0005); 4) higher G-CSF dosage (p < 0.0005); and 5) use of lenograstim rather than filgrastim (p < 0.002). Conclusion In healthy donors it is possible to predict successful HPC mobilization by donor sex, age, WBC count, and G-CSF form and dose. Furthermore, based on these data, it may be possible, at least in parental setting, to modulate G-CSF dosage on the basis of donor characteristics.

Systematic data on the ability of pegfilgrastim to mobilize stem cells after chemotherapy are scarce. We evaluated the efficacy of a single 6mg dose of pegfilgrastim for mobilizing peripheral blood stem cells (PBSC) in aggressive lymphoma patients. Between July 2004 and October 2005, 17 aggressive non-Hodgkin's lymphoma and 11 poor-risk Hodgkin's lymphoma were treated with cycles containing cisplatin-aracytin. At the end of chemotherapy, the patients received 6mg of pegfilgrastim. Duration of grade 4 neutropenia, adverse events, time to neutrophil recovery, peak and harvest of CD34+ cells were recorded. Twenty-seven out of 28 patients harvested a median of 17.3 × 106/CD34+ cells (range 2.5-28.9) after a median of 9 days (range 8-12 days), with a single apheresis procedure in 25 cases. All patients had grade 3-4 neutropenia, median duration 3 days. The only adverse event was mild bone pain. To date, 13 patients have been autografted with a median of 15.4 × 106 CD34+ pegfilgrastim-mobilized cells per kg (range 2.5-28.9) with rapid and sustained engraftment. Mobilization, harvesting and autografting of pegfilgrastim-mobilized PBC can be successfully achieved in pretreated patients with aggressive lymphoma.

Background. Several studies showed the effectiveness of fibrin glue (FG) in reducing bleeding from cut surface in liver resection. This study compares the efficacy in reducing bleeding of a homemade FG, in comparison with a commercial product. Methods. Thirthy-four patients submitted to liver resection for carcinoma were enrolled. Fourteen of them received homemade FG, while the others the commercial product (Tissucol, Baxter). Homemade FG was obtained from allogeneic fresh frozen plasma by using the CryoSeal CS-1 system (Thermogenesis Corp.) device. Fibrinogen concentration in homemade FG was assessed according to the Clauss method. In all the patients the same amount of FG (5 mL) was sprayed on liver cut surface, at the end of the liver resection. Results. Mean fibrinogen concentration in homemade FG was 23.16±5.93mg/mL. In homemade group the baseline haematocrit (Hct) was 40.3±4.1%, in the Tissucol group 40.1±5.4% (p NS). The Hct in 5thpostoperative day was 35±4.1 in group treated with homemade FG, and 32.8±3.8 in pts receiving Tissucol (p<0.05). Blood loss in patients treated by Tissucol was superior to that observed in patients receiving homemade FG (527±251.6 vs 305.6±253.7mL, p<0.05). It has been observed that out of 14 patients treated with homemade FG, 2 (14.3%) received blood transfusion with a mean RBC volume of 500±141.4 mL, in Tissucol group 35% of the patients (p NS) have been transfused and received a mean RBC volume of 542±222.5mL (p NS). Conclusions. Despite the fibrinogen concentration in homemade FG was significantly lower than that reported to be present in Tissucol (75-115mg/mL), the use of homemade product was associated with a statistically significant reduction in blood loss