Hemolytic reactions caused by transfusion of ABO‐incompatible marrow can be ameliorated by either reduction of isohemagglutinins in the recipient or depletion of incompatible red cells from the harvested marrow. This article describes a rapid and reliable method for removal of incompatible marrow red cells on a blood cell processor using a double buffy coat technique. In five allogeneic bone marrow transplants, the maximum value of transfused incompatible red cells was 8.8 ml. There was no evidence of a hemolytic transfusion reaction in any patient. The median cell recovery for nucleated marrow cells and progenitor cells was 77 and 104 percent, respectively. Engraftment occurred at a median of 13 days (range, 11–21 days) after transplantation. The double buffy coat method of red cell depletion is an acceptable method for processing ABO‐incompatible marrow.
The present studies were undertaken to determine whether colony stimulating factor-1 (CSF-1) stimulates hemopoietic cell proliferation and differentiation in vivo. Groups of mice were injected with 25,000 units of pure, endotoxin-free L-cell CSF every 6 hours for intervals up to 8 days. Virtually no changes were detected in blood neutrophils or monocytes. No consistent increases in marrow granulopoiesis were noted. Variable but inconsistent changes in marrow and splenic progenitor cells were noted. Serum CSF was elevated 2 hours after injection but returned to baseline values within 4-6 hours. These studies indicate essentially no effect from exogenous administration of purified CSF; however, higher doses of this factor will be required in further studies.
Tumor necrosis factor (TNF) inhibits hematopoietic cell proliferation. The combination of pentoxifylline (PTX) and ciprofloxacin (Cipro) has been previously shown to reduce circulating serum levels of TNF. In this Phase II trial 14 patients with advanced myelodysplastic syndrome were treated with PTX (2,000 mg/day) and Cipro (1,000 mg/day) in order to determine tolerability and effect on peripheral blood cell counts, progenitor cell responsiveness to cytokines and circulating serum levels of interleukin-6 (IL6) and TNF. Toxicity attributed to PTX and Cipro were limited to nausea in 4 patients. Peripheral blood cell counts, platelet transfusion requirements and red blood cell transfusion requirements did not change during administration of PTX and Cipro (daily for 28 days). Marrow progenitor cells of patients entered into trial were less responsive to stimulation with cytokines in vitro at baseline and during the trial compared to normal volunteers. Eight patients had elevated IL6 levels before treatment with PTX and Cipro these levels did not change during therapy. Five patients had elevated TNF levels at baseline. There was a suggestion of decreased TNF levels during treatment with PTX and Cipro (P = .09). In conclusion, PTX and Cipro was well tolerated but no evidence of efficacy was observed.
Abstract The proliferation and maturation of granulocytic‐monocytic stem cells appears to be controlled by a series of closely related glycoproteins termed “colony‐stimulating factors” (CSFs). Recently, we devised a 6‐step scheme for the purification of murine fibroblast (L‐cell)‐derived CSF. Ten liter pools of conditioned media were concentrated by ultrafiltration, precipitated by ethanol, and separated on DEAE cellulose, Con‐A Sepharose, and Sephadex G 150. The CSF was separated from trace contaminants, including endotoxin, by density gradient centrifugation. The purified material was radioiodinated and used to define the serum half‐life and in vivo distribution. Following IV injection there was a biphasic serum clearance with a t½ of 24–40 min and 2–2½ hours in the first and second phases. Approximately 25% of the tracer was excreted in the urine at 6 h; however, urinary radioactivity was due to low molecular weight peptides. Simultaneous studies by radioimmunoassay showed a similar rapid serum clearance of unlabeled CSF but virtually no urinary CSF activity. Thus, assays for urinary CSF may not provide useful measures of in vivo CSF activity. Further in vitro studies have defined the interaction of CSF with responsive cells in the marrow. Varying doses of CSF were incubated with 10 7 marrow cells for intervals of 24–48 h. The major increment in cell‐associated radioactivity occurred between 6 and 16 h. The reaction was saturable with 1–2 ng/ml CSF. Binding was prevented by cold CSF, but not by other proteins. Irradiation yielded only a minimal reduction in CSF binding. The interaction of CSF with marrow cells appeared to require new protein synthesis, as binding was completely inhibited by cycloheximide and puromycin. Irradiated mice injected with antibodies to CSF showed an inhibition of granulopoiesis by marrow cells in peritoneal diffusion chambers; however, granulopoiesis in the intact bone marrow was unaffected. Granulpoiesis in long‐term marrow cultures was also unaffected by anti‐CSF. These different responses may be due to accelerated clearance of injected CSF in nonirradiated mice or to extensive stromal interactions that modulate and perhaps control granulocytic differentiation in the intact bone marrow microenvironment.
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