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Transfusion. 2008 Sep;48(9):1930-3. doi: 10.1111/j.1537-2995.2008.01777.x. Epub 2008 May 29.

Mobilization, collection, and transplantation of peripheral blood hematopoietic progenitor cells in a patient with multiple myeloma and hemoglobin SC disease.

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Department of Laboratory Medicine and Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.



The use of granulocyte-colony-stimulating factor (G-CSF) for mobilization, collection, and transplantation of autologous hematopoietic progenitor cells (HPCs) in patients with hemoglobinopathies can be complicated by severe vasoocclusive crises. Erythrocytapheresis before G-CSF administration may help prevent these complications. To date, no cases regarding the safety and outcome of erythrocytapheresis followed by autologous high-dose G-CSF mobilization in hemoglobinopathy populations have been reported.


A patient with hemoglobin (Hb) SC disease and multiple myeloma underwent erythrocytapheresis followed by high-dose (16 microg/kg) G-CSF in preparation for HPC mobilization and collection.


Erythrocytapheresis reduced the patient's combined Hb S and C levels to less than 20 percent. Subsequent HPC mobilization and peripheral blood harvesting using high-dose G-CSF yielded approximately 9 x 10(6) CD34+ HPCs per kg over 3 days of collection. Mobilization and leukapheresis were completed without vasoocclusive complications. Two weeks after collection, and after myeloablative chemotherapy, 5.33 x 10(6) CD34+ HPCs per kg were infused to the patient; platelet and white cell engraftment occurred, respectively, on Days +9 and +10 posttransplant. The patient experienced no vasoocclusive complications in the posttransplant period.


The results of this case demonstrate that erythrocytapheresis before high-dose G-CSF HPC mobilization and collection appears to be an effective means for prevention of vasoocclusive crisis in patients with hemoglobinopathies undergoing autologous stem cell transplantation.

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