The impact of recent vincristine on human hematopoietic progenitor cell collection in pediatric patients with central nervous system tumors. Issue 8 (17th February 2014)

• Record Type: Journal Article
• Authors: Cooling, Laura; Bombery, Melissa; Hoffmann, Sandra; Davenport, Robertson; Robertson, Patricia; Levine, John E.
• Is Part Of: Transfusion. Volume 54:Issue 8(2014)
• Page Start: 2004
• Page End: 2014
• Publication Date: 2014-02-17
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.12574
• Languages: English
• ISSNs: 0041-1132

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="trf12574-sec-0001" sec-type="section"> <title>Background</title> <p>Central nervous system (CNS) malignancies represent 20% of all childhood cancers. To improve outcomes in infants and children with high‐risk disease, treatment can include adjuvant chemotherapy and early autologous peripheral blood human progenitor cell collection (AHPCC), followed by high‐dose chemotherapy and stem cell rescue. In many protocols, postoperative chemotherapy includes the administration of weekly vincristine (VCR) between induction chemotherapy cycles, regardless of scheduled AHPCC. We observed anecdotal AHPCC failures in children receiving midcycle VCR (MC‐VCR).</p> </sec> <sec id="trf12574-sec-0002" sec-type="section"> <title>Study Design and Methods</title> <p>The study was an 8‐year retrospective chart review of all children with a CNS malignancy and who underwent AHPCC. Information included patient demographic and clinical data, mobilization regimen, VCR administration, product yields, infusion toxicity, and patient charges. Data were analyzed relative to MC‐VCR administration. Graphics and statistical analysis (t‐test, chi‐square, linear regression) were performed with commercial software.</p> </sec> <sec id="trf12574-sec-0003" sec-type="section"> <title>Results</title> <p>Twenty‐four patients and 47 AHPCCs were available for analysis. Nine patients (37%) received MC‐VCR within 7 days of scheduled AHPCC. MC‐VCR was associated with delayed marrow recovery (17.9 days vs. 14.9 days, p = 0.0012), decreased median peripheral CD34 counts (75 × 10<sup>6</sup> CD34/L vs. 352 × 10<sup>6</sup> CD34/L, p = 0.03), decreased median CD34 yields (2.4 × 10<sup>6</sup> CD34/L vs. 17.8 × 10<sup>6</sup> CD34/kg, p = 0.08), more AHPCCs per mobilization (2.9 vs. 1.1, p = 0.01), and an increased rate of remobilization (33% vs. 6%). Mean patient charges were 2.5× higher in patients receiving MC‐VCR than controls (p = 0.01).</p> </sec> <sec id="trf12574-sec-0004" sec-type="section"> <title>Conclusion</title> <p>MC‐VCR should be withheld before scheduled AHPCC to optimize CD34 collection.</p> </sec> </abstract>