Allogeneic blood stem cell transplantation: considerations for donors

摘要: Allogeneic transplantation of cytokine-mobilized peripheral blood stem cells (PBSCs) is now being increasingly performed, but safety considerations for hematologically normal PBSC donors have not been fully addressed. Progenitors are generally mobilized collection from using recombinant human granulocyte colony-stimulating factor (rhG-CSF). Although the short-term profile rhG-CSF seems acceptable, experience remains limited and its optimal dose schedule defined. Minimal data exist regarding long-term rhG-CSF, primarily derived in patients with chronic neutropenia or cancer. An "ad hoc" workshop was recently convened among a group investigators actively involved field allogeneic cell to discuss issues pertaining donors. There agreement on following points: (1) On basis available data, it appears that treatment an acceptable However, need continued monitoring recognized. (2) doses up 10 microg/kg/d show consistent dose-response relationship mobilization (and collection) CD34+ progenitor cells, this routine clinical use. Whether higher superior (or cost effective) be determined, they may produce more severe side effects. The potential risks marked leukocytosis (arbitrarily defined as leukocyte count than 70 x 10(9)/L) concern, reduction performed by many centers maintain counts below level. (3) Transient post donation cytopenias, involving granulocytes, lymphocytes, platelets, occur at least partly related leukapheresis procedure. These asymptomatic self-limited; follow-up necessarily required. Reinfusion autologous platelet-rich plasma should considered expected postdonation thrombocytopenia (platelet < 80 100 10(9)/L). (4) Donors meet eligibility criteria which apply apheresis exception pediatric also considered. Any deviation these supporting documentation. insufficient information time clearly establish definite contraindications donor. Potential include presence inflammatory, autoimmune, rheumatologic disorders, well atherosclerotic cerebrovascular disease. (5) creation International Donor Registry desirable facilitate effects Individual institutions donor encouraged their own system, preferably standardized approach collection.