La tunisie Medicale - 2022 ; Vol 100 ( n°011 ) : 762-768
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Introduction: The storage of harvested stem cells, in standard refrigerators at +4°C, is a simple and inexpensive alternative to cryopreservation for most patients living in countries with limited resources. We present the 10 years’ experience of our single center from Oran in Algeria using non-cryopreserved stem cells after conditioning with high dose chemotherapy, in a large group of myeloma and lymphoma patients. Methods: From May 2009 to December 2019, autologous stem cell transplantation (ASCT) was carried out in our center, of which 420 with multiple myeloma (MM) and 154 patients with lymphoma. The source of stem cells in all patients consisted of mobilized autologous peripheral blood stem cells (PBSCs). A median of one cytapherisis was performed (range, 1-3) and the products of the aphaeresis were stored in a conventional blood bank refrigerator at +4°C, in 300-mL transfer packs (Baxter Healthcare) composed of impermeable gas, polyvinyl chloride plastic film. The viability of the harvested cells is assessed by flow cytometry using 7’AAD (7 Amino-Actinomycine D) and was determined by a trypan blue dye exclusion test. The chemotherapy conditioning regimen (Mel200, BEAM, CBV, EAM, BeEAM) started once a minimum of 2×106 CD34+cell/kg in MM or 3x106 CD34+cell/kg in lymphoma was obtained. Results: In MM patients, the median age at ASCT was 54 years (range; 27-73). The median harvested CD34+ cell count was 3,2x106/kg (range; 1, 22 to 13, 22) and the viability in all cases being >90%. All patients had engraftment on the median of day 9 (range; 7 to 24) and platelet transfusion independence on the median of day 13 (range; 9 to 39). There was no graft failure. Transplant related mortality (TRM) at 100 days was 3,5%. The overall response to transplant was 99% (complete remission (CR) =64,5%; very good partial remission (VGPR) =34%, partial remission (PR) =1,5%). The estimated overall survival (OS) at 5 years was 68% and the median post-transplant progression-free survival (PFS) was 47 months. On December 31th 2021, 41% patient relapsed and 28% died after disease progression. 305 (75%) patients are alive and 237 (59%) without disease activity after a median follow-up of 52 months (range; 13 to 149). In lymphoma patients, 98 Hodgkin`s lymphoma (HL) and 56 non-Hodgkin´s lymphoma (NHL), were auto grafted. The median age at ASCT was 28 years (range; 16-55) and 33 years (17-61) respectively. After mobilization a median of 4,25x106/kg (NHL) and 4,14x106/kg (HL) of CD34+ was infused and the median viability of the cells after 7 days of refrigeration (trypan blue exclusion) was 82%. The median time to achieve 0,5 G/L neutrophil or more was 14 days (9-44) and 15 days (11-27) in HL and NHL, median time to achieve 20 G/L platelets or more at a median of 16 days (10-37) and 17 days (15-28) in HL and NHL. The OS at 5 years was 76% and 67% for patients with HL and NHL respectively. Transplant related mortality at 100 days was 5% in HL and 12,5% in NHL. Conclusion: This study demonstrates the feasibility of intensified therapy followed by autologous non-cryopreserved PBSCs infusion in MM and lymphoma patients. This method of ASCT is cheaper, and may potentially enable the widespread use of ASCT activities in other hematology centers in Algeria and in developing countries.
Key - Words
  1. Ruiz-Argüelles Gj. Stem Cell Transplantation Procedures Are Becoming Affordable For Individuals Living In Developing (Middle Income) Countries.ActaHaematol. 2016; 135 (2): 79-80.
  2. Wannesson L, Panzarella T, Mikhael J, Keating A. Feasibility and safety of autotransplants with non-cryopreserved marrow or peripheral blood stem cells: a systematic review. Ann Oncol. 2007, 8: 623–632.
  3. Talhi S, Osmani S, Brahimi M, Yafour N, Bouhass R, Arabi A et Al. The use of granulocyte colony stimulating factor (g-CSF) (filgrastim) alone in the mobilization of stem cell in the autologous stem cell transplantation. Transfus Apher Sci. 2013 Aug; 49 (1):97-9.
  4. Yafour N, Brahimi M, Osmani S, Arabi A, Bouhass RA, Bekadja MA. Biosimilar G-CSF (filgrastim) is effective for peripheral blood stem cell mobilization and non-cryopreserved autologous transplantation. Transfusion Clinique et Biologique. 2013, 20 :502–504.
  5. Papadimitriou, C.A., Dimopoulos, M.A., Kouvelis, V. Noncryopreserved peripheral blood progenitor cells collected by a single very large-volume leukapheresis : a simplified and effective procedure for support of high-dose chemotherapy. J ClinApher, 2000,15(4): 236- 241.
  6. Brahimi M, Osmani S, Yafour N, Bekadja S, Bekadja MA. Viability and functionality of non-cryopreservedperipheral stem cellgraftsat + 4°C. Revue Algérienne d’hématologie, 2011, 5: 46-48 (
  7. Puig N, De La Rubia J, RemigiaMj et Al. Morbidity and transplantrelated mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stemcell transplantation. Leukemia Lymphom. 2006; 47: 1488-94.
  8. Bekadja MA. EAM as a new conditioning regimen for lymphoma patients undergoing autologous stem cell transplant. J Blood Lymph, 2014, 4 :e115.
  9. Chantepie S, Tchernonog E, Peyrade F, Larcher MV, Diouf M, Fornecker LM, et Al. Bendamustine-based (BeEAM) conditioning before autologous stem cell transplantation: result of a French multicenter study of 386 patients from LYSA centers. Blood 2016, 128:3450.
  10. Bekadja MA, Bouhass R. Non-cryopreserved peripheral stem cell (PCS) autograft for multiple myeloma and lymphoma in developing countries. Int J Hematology And Therap, 2015, 1(1): 1-6.
  11. Bekadja MA, Brahimi M, Osmani S, Yafour N, Krim A, Serradj F, et al. Hematopoietic stem cell transplantation in Algeria. Hematol Oncol Stem Cell Ther. 2017, (17) 30057-2.
  12. Gonzalez-Lopez Tj, Sanchez-Guijo Fm, Ortin A, Crusoe E, Cordoba I, Corral M, et al. Ischemic stroke associated with the infusion of DMSO-cryopreserved auto-PBSC. Bone Marrow Transplantation 2010; 1-2.
  13. AlessandrinoEp, P Bernasconi P, Colombo A, Caldera D, Martinelli G, Vitulo P, et al. Pulmonary toxicity following carmustine-based preparative regimens and autologous peripheral blood progenitor cell transplantation in hematological malignancies. Bone Marrow Transplantation (2000) 25, 309–313.
  14. Bekadja MA, Brahimi M, Osmani S, Arabi A, Bouhass R, et al. A simplified method for autologous stem cell transplantation in multiple myeloma. HematolOncol Stem Cell Ther, 2012, 5: 49-53.
  15. Kayal, S., Sharma, A., Iqbal, S., et al. High-dose chemotherapy and autologous stem cell transplantation in multiple myeloma: a single institution experience at all India institute of medical sciences, New Delhi, using non-cryopreserved peripheral blood stem cells. Clinical Lymphoma,Myeloma& Leukemia, 2014, 14(2): 140-147.
  16. Bekadja MA, Brahimi M, Osmani S, Talhi S, Amani K, Ouldjeriouat H. Non- cryopreserved hematopoietic stem cell transplantation in multiple myeloma. A single center experience in Oran (Algeria). Blood, 2015,126:1990.
  17. Mabed, M., Shamaa, S. High-dose chemotherapy plus noncryopreserved autologous peripheral blood stem cell transplantation rescue for patients with refractory or relapsed Hodgkin disease. Biology of Blood and Marrow Transplantation, 2006, 12(9): 942-948
  18. Karduss-Urueta Aj, Druiz-Arguelles Gj, Frcp (Glasg), Perez R, Ruiz-Delgado Gj, Cardona Am, et al. Cell-Freezing devices are not strictly needed to start an autologous hematopoietic transplantation program: Non-cryopreserved peripheral blood stem cells can be used to restore hematopoiesis after high dose chemotherapy: A multicenter experience in 268 autografts in patients with Multiple Myeloma or Lymphoma. Study on behalf of the Latin- American Bone Marrow Transplantation Group (LABMT). Blood, 2014, 124: 849.
  19. Bekadja MA, Boumendil A, Blaise D, Patrice Chevallier P, Karl S Peggs K S, Salles G et al. Non-cryopreserved hematopoietic stem cells in autograft patients with lymphoma: a matched-pair analysis comparing a single center experience with the use of cryopreserved stem cells reported to the European Society for Blood and Marrow Transplantation registry. Cytotherapy. 2021, 23 (6): 483-487.
  20. Sierra J, Conde E, Iriondo A, Brunet S, Marin J, Perez De Oteiza J et al. Frozen vs non frozen bone marrow for autologous transplantation in lymphomas: a report from the Spanish GEL/ TAMO cooperative group.Ann Hematol 1993; 67: 111–114.
  21. Carella, A.M., Bellei, M., Brice, P., et al. High-dose therapy and autologous stem cell transplantation versus conventional therapy for patients with advanced Hodgkin’s lymphoma responding to front-line therapy: long-term results. (2009) Haematologica 94 (1): 146-148.
  22. Van Den Neste, E., Casasnovas, O., Andre, M., et al. Classical Hodgkin’s lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant. (2013) Haematologica 98(8): 1185-1195.
  23. Ferme C, Mounier N, Divine M Et Al. Intensive salvage chemotherapy with high-dose chemotherapy for patients with advanced Hodgkin in relapse or failure after initial chemotherapy: results of the GELA h89 trial. J Clin Oncol, 2002, 20:467-475.
  24. Cook G, Williams C, Brown JM, et al. High-dose chemotherapy plus autologous stem-cell transplantation as consolidation therapy in patients with relapsed multiple myeloma after previous autologous stem-cell transplantation (NCRI Myeloma X Relapse [Intensive trial]): a randomised, open-label, phase 3 trial. 2014, The lancet oncology 15(8): 874-885.
  25. Faucher C, Le Corroller Soriano Ag, Esterni B, Vey N, Stoppa Am, Chabannon C, et al. Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs. Bone Marrow Transplant. 2011; Jul 4.
  26. Clemmons Ab, Anderegg S. Mixed outpatient-inpatient autologous stem cell transplant for multiple myeloma: a cost-saving initiative in a resource constrained environment. J Oncol Pharm Pract. 2017; 23(5):384-388.
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Tunisia treatment diagnosis Child surgery prognosis epidemiology Children Risk factors prevalence Crohn’s disease Breast cancer screening obesity Cancer
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