From the Guidelines
The patient undergoing Peripheral Blood Stem Cell (PBSC) transplantation today should receive mobilization therapy with granulocyte colony-stimulating factor (G-CSF) such as filgrastim at 10 μg/kg/day for 4-5 days, sometimes combined with plerixafor (0.24 mg/kg) if needed, to stimulate stem cell production and release into the bloodstream, as this approach has been shown to be effective in mobilizing PBSCs and reducing the duration of neutropenia after transplantation 1.
The process of PBSC transplantation involves several key steps, including:
- A thorough medical evaluation to ensure the patient can tolerate the procedure
- Placement of a central venous catheter for medication administration and stem cell collection
- Mobilization therapy with G-CSF, such as filgrastim, to stimulate stem cell production and release into the bloodstream
- Collection of stem cells through apheresis, usually requiring 1-3 sessions to obtain sufficient cells (minimum 2 million CD34+ cells/kg)
- Conditioning therapy with chemotherapy and/or radiation to eliminate diseased cells and create space for new stem cells
- Infusion of the collected stem cells intravenously, similar to a blood transfusion, taking 30-60 minutes
After transplantation, patients require close monitoring for complications like infections, graft-versus-host disease, and organ damage, while receiving supportive care including antibiotics, transfusions, and nutritional support 1. The use of G-CSF after autologous transplantation has been associated with savings in the duration of hospitalization and overall medical costs, but its use after allogeneic transplantation has been shown to increase the incidence of severe graft-versus-host disease and reduce survival 1.
The recommended dose of G-CSF is 10 μg/kg daily for 4-5 days, with or without chemotherapy, as this has been shown to be effective in mobilizing PBSCs and reducing the duration of neutropenia after transplantation 1. The addition of plerixafor to chemomobilization has been shown to accelerate an increase in PBSC count and may be used as a rescue strategy when PBSC yield is poor, or when the CD34+ cell count does not reach the target level 1.
Recovery from PBSC transplantation typically takes weeks to months as the new stem cells engraft and begin producing healthy blood cells, with regular follow-up appointments to monitor progress and manage any long-term effects 1.
From the Research
Necessary Steps for a Patient Undergoing Peripheral Blood Stem Cell (PBSC) Transplantation
- Prepare the patient for the transplantation process by ensuring they understand the procedure and its potential risks and benefits 2
- Administer graft-versus-host disease (GVHD) prophylaxis, such as post-transplant cyclophosphamide (PTCy) or tacrolimus and methotrexate (Tac/MTX), to prevent GVHD 3, 4
- Monitor the patient's vital signs and laboratory results closely during the transplantation process and after discharge 5, 6
- Provide supportive care, such as pain management and anti-emetics, as needed to manage side effects of the transplantation process 2
GVHD Prophylaxis Options
- Post-transplant cyclophosphamide (PTCy) has been shown to be effective in preventing GVHD in patients undergoing PBSC transplantation from HLA-matched donors 3, 4
- Tacrolimus and methotrexate (Tac/MTX) is a commonly used GVHD prophylaxis regimen, but may have a higher risk of chronic GVHD compared to PTCy 6, 4
- The choice of GVHD prophylaxis regimen should be individualized based on the patient's specific needs and risk factors 2
Monitoring and Management of GVHD
- Close monitoring of the patient for signs and symptoms of GVHD, such as skin rash, diarrhea, and liver dysfunction, is essential 5, 6
- Grade II-IV acute GVHD and grades III-IV GVHD require prompt treatment with immunosuppressive agents, such as corticosteroids and calcineurin inhibitors 2
- Chronic GVHD may require long-term immunosuppressive therapy and supportive care to manage symptoms and prevent complications 2