Transfusion requirements in autologous stem cell transplantation: a single-center-experience

1. Transfusion requirements in autologous stem cell transplantation: a single-center-experience Sousse 26 05 2012

2. INTRODUCTION • The transfusion support in peripheral blood stem cell transplantation is critical to the outcome of patients. • Aim of this study : evaluate the transfusion requirements in autologous stem cell transplantation.

3. METHODS • retrospective study • 30 patients/ Lymphoma • Autologous peripheral blood stem cell transplantations • 2010-2011

4. PATHOLOGY

5. Median age :30 years (range: 16-59). • sex ratio=2: • 20 Males (67%) • 10 Females (33%)

6. CONDITIONING REGIMEN : (BEAM) • Carmustine (BCNU):300mg/m² at the day(-7) • Etoposide: 200 mg/m² from day(-6) to day(-3) • Cytarabine:200mg/m² twice a day ,from day (-6) to day(-3) • Melphalan:140mg/m² at the day (-2) • G-CSF (5ug/kg/day): • From day 5 to neutrophils recovery (>1000/mm3)

7. Graft : 5,83 x10⁶ CD34/kg (range: 3- 14,95) • median duration of chemotherapy –induced aplasia : 10 days (range 7-40).

8. TRANSFUSION INDICATIONS • Red Blood cell units: Hemoglobin level <8g/dl Poorly tolerated anemia • Platelet concentrates: Platelet count <20.000 bleeding

9. Total Blood products transfusion • 39packed red blood cell units • 47 apheresis platelet concentrates • 16 standard platelet transfusions: 99 SPC

10. RED BLOOD CELL TRANSFUSION • Mediandelay for redbloodcell transfusion: • 5 daysafterautograft (2 -9)

11. RED BLOOD CELL TRANSFUSION • 15 patients (50%) • median number of transfused packed red blood cell units per patient : 2 (1-10). • median hemoglobin level before RBC transfusion : 6,8 g/dl (range 5,4 -8,7)

12. RED BLOOD CELL TRANSFUSION • No RBC transfusions : 50 % Median age : 30 years (range: 16- 59) Sex: 12 males, 3 females Pathology: 12 non Hodgkin lymphoma (2B) 3 Hodgkin lymphoma Graft : median of 5,79 x 10⁶ CD34/kg (range:3,6-14,45) No difference in CD 34 + with transfused group

13. PLATELET CONCENTRATES TRANSFUSION 29 patients (96.6%) Delay for PC transfusion: • 6 daysafterautograft (2-6) • Number of platelet transfusion sessions per patient :2 (1-8). • Platelet count before platelet transfusion: 8000 (2000-26000)

14. Transfusion free auto stem cell transplantation • One patient wasn’t transfused at all. Age: 30 years Sex: M B- Cell lymphoma (CR1) Graft: 9,16x 10⁶ CD34+/kg Duration of aplasia: 10 days

15. DISCUSSION • Transfusion requirements during autologous stem cell transplantation are not very important. • In our patients : no influencing factors • Littérature : • young age • number of CD34 infused +++

17. CD 34 +++ • ≥ 5x 10⁶ /kg of CD34+ cells shortenshematopoieticrecovery reduces the platelet transfusion requirements.

19. thrombopenia at the initiation of autologous transplantation is associated with increased platelet transfusion requirements independent of the dose of CD34+ cells infused

21. IL 11 : cytokine - stimulateshematopoietic stem cells, and MGC - increases the speed of plateletrecovery -reduces platelet transfusions in autologous stem cell transplantation no clinicalbenefit !!! • TPO, IL 6 regulate, stimulatethrombopoiesis • IL 11 : interest ?? Cost???

23. Erythropoietinpreventsapoptosis of lateerythroidprogenitos and proerythroblasts No interestwhenlevel of endogenous Epo ishigh Early :No benefit of Epo : not enougherythroidprecursos to respond !!! • >Day 28 : Epo isvery efficient Cost ???

24. Immature (or reticulated) platelets (PLTs) contain more RNA than mature PLTs reflect the rate of thrombopoiesis. Immature PLTs are more active because of their higher nucleic acid content and higher expression of P-selectin and glycoprotein. efficacy of transfusion with rich IPF was higher than that of low IPF transfusion

26. CONCLUSION • Transfusion requirements in autologous stem cell transplantation are not important. • CD34+ cells ≥ 5x 10⁶ /kg No confirmed in our study Larger series +++ • Interest of Transfusion-free autograft in our context ?

27. Thanks for attention