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Neutrophil and platelet engraftment times are significantly shorter in patients undergoing PBPCT compared with ABMT. The explanation for this is unclear. The reticulated platelet percentage (RP%) has been established as a measure of bone marrow platelet production. Using this measurement we have followed thrombopoiesis over the transplant period in 10 patients undergoing PBPCT, eight ABMT and four alloBMT. Neutrophil and platelet engraftment times were significantly shorter in patients undergoing PBPCT than either ABMT or alloBMT. The RP% fell to a nadir in parallel with the platelet count in all patients following conditioning therapy consistent with an aplastic state and rose before platelet recovery as young platelets were released. The peak rise in the RP% was significantly greater and occurred earlier in PBPCT compared with BMT. The total number of reticulated platelets released during the time of engraftment was significantly greater in PBPCT than BMT. The potential role of the RP% in the timing of thrombopoietin therapy is explored. Finally the diagnostic use of the RP% in post-transplant thrombocytopenia is illustrated by a case in which a persistently high RP% accurately predicted a consumptive aetiology.

We have investigated the toxicity of dose-escalation of BCNU, etoposide and melphalan ('BEM') chemotherapy with autologous stem cell transplantation in patients with haematological malignancies. Seventy-two patients with haematological malignancies were treated with BCNU (600 mg/m2, 450 mg/m2 or 300 mg/m2), etoposide 2 g/m2 and melphalan 140 mg/m2 followed by autologous bone marrow transplantation (ABMT), n = 51, or autologous peripheral blood progenitor cell transplantation (APBPCT), n = 21. Liver and pulmonary function was monitored pretransplant and at regular intervals post-transplant. Mucositis was graded daily during in-patient stay. There was a significantly higher incidence of symptomatic pulmonary toxicity in the patients who received BCNU at 600 mg/m2 than in the other two groups, and there was a significant increase in the incidence of asymptomatic decrease in carbon monoxide (KCO) in the patients who received BCNU 450 mg/m2. There was no significant difference between the three groups in the incidence and severity of mucositis or in the incidence of transiently abnormal liver function. We conclude that etoposide at 2 g/m2 can be used without unacceptable mucositis. BCNU at 600 mg/m2 is associated with an unacceptably high incidence of lung toxicity, but at 450 mg/m2 there is minimal symptomatic lung toxicity.

We report the results of peripheral blood progenitor cell (PBPC) harvesting in 22 patients with lymphoma who underwent leucapheresis after cells were mobilised using 3 g/m2 cyclophosphamide and G-CSF. In 19 patients, the total CFU-GM collected was greater than 7.5 x 10(4)/kg. These patients underwent successful autologous PBPC transplantation. This group of patients was compared to a historical group of 24 patients with lymphoma who underwent ABMT with the same conditioning chemotherapy. The time to engraftment of neutrophils to 0.5 x 10(9)/l was significantly reduced (median 11 days vs 19 days, P < 0.0001) and consequently in-patient stay was reduced (median 21 days vs 28 days, P < 0.001). Blood product support (median 3 vs 4 units blood, P = 0.02; median 15 vs 40 units platelets, P = 0.005) and use of TPN (median 0 days vs 8 days, P < 0.001) were reduced. We estimate a saving of approximately pounds 2370 per patient using PBPC for autologous transplantation compared to bone marrow progenitor cells. This saving is significant (P < 0.001).