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R Scimè

Publications and source records attributed to R Scimè.

25 records · Page 2Linked to original sources
PubMed1991

Treatment of malignant lymphomas with very-high-dose CVB followed by transplantation of autologous blood stem cells collected after mobilizing chemotherapy.

In 8 patients (age 25 +/- 46 years, mean 34.5), 4 with Hodgkin's disease (HD) and 4 with non-Hodgkin's lymphoma (NHL), circulating stem cells (CSC) collected at the time of rapid leukocyte and platelet recovery after intense chemotherapy were employed for autologous hematological reconstitution after very-high-dose chemotherapy (CVB combination). At the time of graft 2 patients were in 1st remission and 2 in 2nd, while the remaining 4 had persistence or progression of disease. Autografted patients received 3.4 +/- 8.3 (mean 5.2) x 10e8/Kg mononuclear cells and 2.1 +/- 40.5 (mean 22.5) x 10e4/Kg CFU-GM. All patients had prompt and sustained engraftment, though in one case platelets never reached normal levels. Recovery time was respectively 10 +/- 17 days (mean 13.2) for granulocytes 0.5 x 10e9/L, and 10 +/- 49 days (mean 20.3) for platelets greater than 50.0 x 10e9/L, with an interval of less than 4 days from greater than 0.5 to greater than 1.0 granulocytes in 7 out of the 8 patients. All patients are currently alive at 57 +/- 645 (median 262) days, and 7 in remission at 61 +/- 645 (median 297) days from autologous blood stem cell transplantation (ABSCT). Our study demonstrates that CSC collected after mobilizing chemotherapy are able to promptly restore and sustain hemopoiesis after marrow ablative chemotherapy in patients with malignant lymphoma. CSC reduce toxicity and hospitalization so impressive, that in malignant lymphomas ABSCT could rapidly be considered for first line strategy.

Adult↗
PubMedDate not supplied

Collection of PBSC with Fenwal CS-3000 for autografting.

The peripheral blood represents an alternative source of haemopoietic progenitors and permits autografting in patients who have contraindications for a bone marrow harvest but who are otherwise candidates for autologous bone marrow transplantation. Circulating stem cells can be harvested performing several leucaphereses during the overshoot after a mobilization chemotherapy. The use of Fenwal CS-3000 cell separator allows reproducibility from donor to donor and makes the procedure very efficient. We collected peripheral blood stem cells (PBSC) in four patients, 2 with Hodgkin's lymphoma, 1 with high-grade non-Hodgkin's lymphoma and 1 with secondary FAB unclassifiable ANLL: the procedures of collection and cell harvests obtained are reported.

Adult↗
PubMedDate not supplied

Circulating stem cell autograft in malignant lymphomas.

Autologous peripheral blood stem cells (PBSC) collected after an intensive course of chemotherapy were employed for hematological reconstitution in 3 patients (age 24-44 years), 2 with Hodgkin's and 1 with high-grade non-Hodgkin's lymphoma, in 2nd complete or partial remission. PBSC collections were performed with a Fenwal CS-3000 cell separator (programs "3" and "1-modified"). After collection and partial RBC removal, cells were cryopreserved and stocked in liquid nitrogen. In all patients the CVB combination was employed as myeloablative transplant regimen. Patients received respectively 28.0, 33.1 and 12.3 x 10(4)/Kg peripheral blood CFU.GM. Hematologic recovery was prompt and complete in 2 patients, while a patient with Hodgkin's lymphoma who had previously been treated with combined modality, is still moderately thrombocytopenic and granulocytopenic 148 days post graft. Patients are currently alive and disease-free 148-301 days post graft.

Adult↗
PubMedDate not supplied

Mobilization of circulating progenitor cells in multiple myeloma during VCAD therapy with or without rhG-CSF.

BACKGROUND: Circulating progenitor cells (CPC), when infused in large numbers, rapidly repopulate the marrow after myeloablation with high-dose therapy. In multiple myeloma (MM), as in other disorders, different chemotherapy regimens, including single-as well as multiple-agent chemotherapy, with or without hemopoietic growth factors, have been proposed to mobilize these progenitor cells into the blood. Here we report our experience with a drug combination called VCAD and compare the results to those obtained by adding rhG-CSF to the same combination. METHODS: Fourteen MM patients were given one course of VCAD, a chemotherapy association of vincristine 2 mg, cyclophosphamide 4 x 0.5 g/m2, adriamycin 2 x 50 mg/m2 and dexamethasone 4 x 40 mg, before undergoing apheresis to collect CPC for autografting. Seven also received rhG-CSF (filgrastim) 5 mcg/kg/day over the period of apheresis. These latter were allocated to rhG-CSF treatment sequentially from the time the drug became available for clinical use. RESULTS: Following VCAD-induced pancytopenia, CFU-GM peaked at a median of 853/mL (range 96-4352; 7.6 times basal level). RhG-CSF administration increased CFU-GM levels but not significantly. With rhG-CSF the CFU-GM peak was reached sooner, toxicity was reduced and granulocytopenia less protracted. Fewer aphereses were run in the rhG-CSF group, there were higher yields per single run, and patients began and completed their collection program more quickly. CONCLUSIONS: The VCAD association is able to mobilize CPC in patients with MM, and rhG-CSF is recommended as a fundamental part of the priming schedule.

Adult↗
PubMedDate not supplied

Engraftment kinetics and long-term stability of hematopoiesis following autografting of peripheral blood stem cells.

BACKGROUND: We analyzed short-term and sustained hematopoietic reconstitution after high-dose therapy with peripheral blood stem cell (PBSC) support in patients with various malignant disorders. METHODS: Fifty-six patients, all with malignant hematologic disorders, were autografted between 1989 and 1994 using PBSC (47 pts) or PBSC + bone marrow (BM) cells (9 pts). PBSC were collected after mobilization with chemotherapy +/- hematopoietic growth factors (GF). RESULTS: All patients engrafted > 0.5 x 10(9)/L polymorphonuclear cells (PMN) and > 50.0 x 10(9)/L Plt at a median of 12 (8-32) and 13 (9-365) days, respectively. Thirty-nine patients were evaluable for long-term graft performance, and their hematologic values at 30 and 100 days, at 6 months and at 1, 2, 3, 4 and 5 years were retrospectively analyzed. Steady counts were recorded over the years. None of the patients had late graft failure. CONCLUSIONS: PBSC given after high-dose chemotherapy ensure a fast hematologic recovery with stable graft performance up to five years after autograft. Though this is not definitive proof of the presence of uncommitted stem cells in the PBSC population, it gives further support to the idea that PBSC are as safe as bone marrow for long-term engraftment. A delayed or incomplete recovery of platelets may occur with low PBSC counts or when disease relapse occurs rapidly after autograft.

Adolescent↗
PubMedDate not supplied

Testicular relapse of AML during chronic graft-versus-host disease induced by donor leukocyte infusion.

Treatment options for acute leukemia relapsing after allogeneic BMT include conventional chemotherapy or a second transplant; however, results are rather discouraging, the first option being associated with poor survival and the second with a high mortality rate. More recently, donor leukocyte infusion (DLI) from the original donor has been used for relapsed patients in an attempt to induce a graft-versus-leukemia (GVL) effect. This procedure is partially devoid of the toxicity inherent to a second BMT. At our Institution, a 36-year-old patient with biphenotypic AML in second complete remission after relapse following allogeneic BMT was treated with peripheral blood stem cell (PBSC)-enriched donor leukocytes, obtained after in vivo priming with rhG-CSF. The patient experienced extensive cGVHD but developed a testicular relapse while in full hematologic remission. After irradiation of the sanctuary site he remains free of disease, still with chronic GVHD, 21 months after bone marrow relapse. This case suggests that immunologically privileged sites are inaccessible to GVHD/GVL effect. This should be considered when planning salvage transplants procedures in patients at risk for extramedullary involvement.

Adult↗