Bone marrow cryopreservation and clinical implications in autologous bone marrow transplantation

A simple, rapid and effective technique using the IBM (Cobe)-2991 cell processor for the concentration of buffy coat cells from large volume marrow has been well adopted (n = 16). Only about one-eighth of the original volume was obtained while retaining more than 90% of the total nucleated cells to be cryopreserved in polyolefine bags with TC-199 culture medium and final 10% dimethylsulfoxide (DMSO) (n = 9), processed by a computerized Nicool ST-20 (France) programmed freezer and stored in a vapor phase of liquid nitrogen at -196 degrees C. Stem cell assay by CFU-GM after thawing yielded a mean of 50.39 +/- 19.54% which has been satisfactory for clinical implementation. So far, three cases with hematological malignancies had been rescued by autologous cryopreserved marrow after supralethal doses of chemoradiotherapy. Two patients with acute nonlymphocytic leukemia transplanted in 1st remission as of Oct. 31 had been disease free for 178+ and 157+ days, respectively, after transplant which was taken at the corresponding age of 53 and 42 years. The other patient who was a victim of Hodgkin's disease, stage IV, and was transplanted in 3rd remission, expired on the 59th day because of the complication of idiopathic interstitial pneumonitis despite excellent granulocytopoietic reconstitution. The preliminary results are encouraging for further exploitation, especially for those who would otherwise be candidates for allogeneic bone marrow transplantation but are limited by age or lack of an HLA-identical sibling to serve as marrow donors.     

No narcosis for bone marrow harvest in autologous bone marrow transplantation

A prospective study with mild general analgesia and sedation together with local anesthesia during bone marrow harvest was performed. Thirty-one patients underwent 33 bone marrow collections. Pretreatment consisted of 100 mg meperidine i.m. and 20 mg diazepam i.m. 1 h before start of procedure. Eight patients got additional meperidine and diazepam during the procedure, all patients got lidocaine 1% locally. A mean volume of 1.321 was obtained with 42.5 punctures. Twenty-two patients had no complications, 4 vomited, 4 had easily correctable hypotension of short duration, one got oxygen for cyanosis of short duration. Acceptance was good in 23 patients, in 6 reasonably well, in two bad. Only one patient experienced pain problems, due to suction. Anxiety was no major problem due to good information before the procedure and mild sedation. This form of anesthesia for bone marrow collection is a safe procedure, it is generally well accepted by the patient and it can be performed on an out-patient basis.     

Experience with using cefoperazone in cancer patients after bone marrow transplantation]

Cefoperazone is a semisynthetic cephalosporin of the 3rd generation (cefobid, Pfizer, USA). It was used in monotherapy of 12 oncological patients during ++post-cytostatic aplasia of the bone marrow and peripheral pancytopenia after bone marrow transplantation. The results were favourable in 67 per cent of the patients: the body temperature normalized and no signs of any infection were evident. In 25 per cent of the patients the monotherapy failed and it was necessary to combine cefoperazone with aminoglycosides. Therefore, cefoperazone proved to be an efficient antibacterial drug, whose use was possible in the monotherapy of oncological patients after transplantation of the bone marrow.     

Experience with bone marrow transplantation for inborn errors of metabolism

Westminster experience had by 1973 evolved the concept of displacement bone marrow transplantation and extended the donors from matched siblings to other family and unrelated donors. The principles of its use to install donor bone marrow as a component factory for the life of the recipient, together with the importance of immunoprophylaxis are detailed. Satisfying correction has been achieved for 48 previously fatal genetic diseases, partial correction for another 5 with failure for 3 diseases. Displacement bone marrow transplantation is not a panacea, but could be applied to about 7% of known inborn errors, devising in vitro tests which can predict in vivo donor effects, especially since some 80% of our patients are not found in known families and could not have been prevented.     

Frontiers in bone marrow transplantation

The early murine experiments and human studies that indicated the potential of marrow transplantation are reviewed. The results of marrow grafting for a variety of human diseases are summarized. Current directions of research are indicated.     

Fetal cord blood's potential for bone marrow transplantation

Approximately 18 years ago, the authors were able to produce an apparently successful bone marrow transplant by using umbilical cord blood. In view of the Chernobyl disaster and the subsequent problems of treatment with marrow transplantation, this study undertook to explore further the potential use of umbilical cord blood as a source of marrow cells. Specimens of umbilical cord blood were collected from 13 routine obstetrical deliveries. All specimens grew erythroid and granulocytic-monocytic colonies. The formation of these various hematopoietic colonies from umbilical cord blood was at least equivalent to bone marrow, and in some instances over 5 times more effective. There appeared to be a statistically significant correlation between the numbers of colony-forming units (CFU-E) and the male infants. The weight of the infants also showed a statistically significant correlation with the burst forming units, erythroid (BFU-E) and the granulocytic-monocytic colony (CFU-GM). The BFU-E also appeared to be greater in number when the time between collection and plating was shorter.     

Preparing the patient for bone marrow transplantation: nursing care issues

The phases of bone marrow transplantation can be identified as the pre-transplant period, the immediate post-transplant period, and the late post-transplant period. The pre-transplant period is characterized by identification of the appropriate type of transplant to be done and, if necessary, finding an appropriate donor; entry of the patient into the transplant unit; administration of the preparative chemotherapy/irradiation regime; management of early toxicities; and pre-transplant supportive care. Nurses play an integral role during the entire transplant process. During the pre-transplant phase, nursing expertise is exemplified in the administration of chemotherapy, management of side effects, teaching of transplant procedures to patient and family, and supportive care. This paper reviews the patient care issues during the pre-transplant phase of bone marrow transplantation and identifies nursing management strategies.     

The cytopathology of bone marrow transplantation

Bone marrow transplantation (BMT) is an increasingly effective treatment for patients with hematologic disorders and malignant neoplasms. From 1975 to 1986, 1,457 specimens were obtained for cytologic evaluation from 328 of the 635 patients who received BMTs at Memorial Sloan-Kettering Cancer Center. These specimens consisted of 1,049 cerebrospinal fluids (CSFs) from 265 patients, 292 bronchoscopy specimens from 92 symptomatic patients and 116 other specimens (including brushings from the liver and gastrointestinal tract, sputa, urines and cervico-vaginal smears). CSF specimens examined before and after BMT from 80 (30%) patients showed an increased number of benign, nonepithelial cells, which were mainly lymphocytic or histiocytic in origin. Malignant cells were detected in CSF specimens from 44 (17%) patients. Bronchoscopy specimens from 3 patients had suspicious cells present; those from 27 patients contained opportunistic organisms. Atypical epithelial or lymphoreticular cells were seen in bronchial specimens from 49 patients. All cytologic findings were correlated with the pertinent clinical information as well as biopsy and autopsy material, including histopathologic evidence of graft-versus-host disease. Cytologic evaluation, especially of bronchial and CSF specimens, was useful in diagnosing the presence of malignant neoplasms, infectious organisms, inflammatory responses, reactive lesions and cellular atypia due to treatment.     

Immunoreconstitution after human bone marrow transplantation

Immunologic reconstitution was studied in 24 patients who underwent bone marrow transplantation, 17 allogenic and 7 autologous. The GVHD prophylaxis consisted of methotrexate and prednisone. The complete immune evaluation was to be carried out prior to transplantation at 1, 2, 3, 6, 9, 12 months after BMT and subsequently every 6 months up to 4 years. The investigated immunological parameters included total lymphocyte count, B-lymphocytes, T3-, T4-, T8-lymphocytes, T4/T8 ratio, natural killer cell activity, ADCC, lymphocyte blastogenic response and serum-IgG, -IgA, -IgM. Absolute lymphocyte count, B-lymphocytes, T3-lymphocytes recovered to normal levels after 6 months. T4-lymphocytes decreased significantly during the first 180 days posttransplant. T8-lymphocytes increased after 6 months to values higher than normal and the T4/T8 ratio decreased significantly and continued below 0.8 for 48 months. Patients without and with GVHD had low lymphocyte response to PHA and Con A for the first 6 months.     

Supportive haemotherapy in bone marrow transplantation

The intensive supportive haemotherapy which has to be used in bone marrow transplantation is discussed, taking mainly into account platelet transfusions. Ways to avoid alloimmunizations against platelet antigens, especially HLA-ABC antigens, are shown (use of HLA-AB homozygous donors or of cross-reacting groups).