Autologous hematopoietic stem cell transplant at a tertiary care centre in India: achieving comparable outcomes with adaptations.

Blood cell therapy Pub Date : 2024-02-16 eCollection Date: 2024-02-25 DOI:10.31547/bct-2023-016
Aditya Kumar Gupta, Jagdish Prasad Meena, Rachna Seth, Priyanka Naranje, Sujata Mohanty, Poonam Coshic
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Abstract

Autologous stem cell transplantation (ASCT) is the standard treatment for many high-risk solid tumors. Patients undergoing ASCT should be managed in a dedicated hematopoietic stem cell transplantation (HSCT) unit with isolation rooms, high-efficiency particulate air (HEPA) filters, and positive pressure. We report the outcomes of the first 20 pediatric patients who underwent ASCT in isolation rooms with no HEPA filters or positive pressure. Moreover, the isolation rooms were not part of a dedicated HSCT unit. Data from 20 patients were analyzed. All patients included in the study underwent ASCT after harvest and cryopreservation of the hematopoietic stem cells (HSC). Furthermore, all patients also underwent myeloablative conditioning. The most common indications for ASCT included high-risk neuroblastoma (HR-NB) (n=9) and refractory/relapsed Hodgkin's lymphoma (HL) (n=6). The median CD-34 positive HSC administered was 4.5 (0.8-21.9) million per kg. The median time to neutrophil and platelet engraftment was 16.5 (10-35) and 19 (10-87) days, respectively. Additionally, only one transplant-related mortality was observed and the mean time to discharge from the hospital was 27.6+8.3 days. The overall survival for all our patients was 75% at a median follow-up of 33.2 months (15 out of 20 patients survived), and the disease-free survival was 60% (median follow-up, 28.4 months). The overall survival for the patients with HL was 85.7% at a median of 45.3 months and for the HR-NB was 66.7% at a median of 34.9 months. This study provides evidence that ASCT can be safely performed in isolation rooms without HEPA filters and positive pressure if expertise and supportive care are available. In settings with limited resources, such a model could help establish low-cost HSCT units.

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印度一家三级医疗中心的自体造血干细胞移植:通过调整实现可比结果。
自体干细胞移植(ASCT)是许多高危实体瘤的标准治疗方法。接受自体干细胞移植的患者应在设有隔离室、高效微粒空气过滤器(HEPA)和正压的专用造血干细胞移植(HSCT)病房进行管理。我们报告了首批在无高效微粒空气过滤器或正压的隔离室中接受造血干细胞移植的20名儿童患者的治疗结果。此外,这些隔离室并非造血干细胞移植专用病房的一部分。研究分析了 20 名患者的数据。所有参与研究的患者都在采集造血干细胞并进行冷冻保存后接受了造血干细胞移植。此外,所有患者还接受了骨髓溶解调理。ASCT最常见的适应症包括高危神经母细胞瘤(HR-NB)(9例)和难治/复发性霍奇金淋巴瘤(HL)(6例)。CD-34阳性造血干细胞中位数为每公斤450万(80万-2190万)。中性粒细胞和血小板移植的中位时间分别为 16.5 (10-35) 天和 19 (10-87) 天。此外,仅观察到一起移植相关死亡病例,平均出院时间为 27.6+8.3 天。中位随访时间为 33.2 个月,所有患者的总生存率为 75%(20 位患者中有 15 位存活),无病生存率为 60%(中位随访时间为 28.4 个月)。HL患者的总生存率为85.7%,中位随访时间为45.3个月;HR-NB患者的总生存率为66.7%,中位随访时间为34.9个月。这项研究提供的证据表明,如果有专业知识和支持性护理,在没有高效空气过滤器和正压的隔离室中也可以安全地进行 ASCT。在资源有限的情况下,这种模式有助于建立低成本的造血干细胞移植单位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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