Most patients who need peripheral blood stem cell transplantation do not have peripheral venous access that would allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis-related access failure. A technique has been developed for translumbar placement of permanent, subcutaneously tunneled, silicone rubber apheresis catheters into the inferior vena cava, and 40 of these catheters have been placed in 36 patients for stem cell collection. Twenty-six catheters have been left in place for venous access during the transplantation procedure. These catheters had a very low rate (2.3%) of apheresis-related related complications. Access failure was attributed to thrombosis in 10 catheters (25%) and to mechanical complications in another 9 (22%), but access was regained in all but 4 of these cases. The catheters functioned well as venous access devices during transplantation, only rarely developing complications during that time. Venograms performed at the time of removal of 16 catheters showed no case of caval occlusion. A residual fibrin sheath was found around 14 catheters. There was no clinical or computed tomographic scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed, translumbar inferior vena cava apheresis catheters provide a safe and effective route for the collection of peripheral blood stem cells for transplantation, and they can be left in place for venous access during transplantation.

Catheterization, Peripheral↗

PubMedDate not supplied

Collection of autologous peripheral blood stem cells in steady state.

Cells normally present in the circulation are capable of providing sustained haematopoietic function in a manner similar to cells normally present in the bone marrow, when transplanted to an autologous or allogeneic recipient. The function of these circulating cells is not known, but they may serve as a reservoir of haematopoietic stem cells which can migrate via the blood stream to sites of need when called upon, thereby providing a protective role. In the past, these cells were collected from the blood during steady-state marrow function to serve as both autologous and allogeneic graft products for transplantation. While this application has since been abandoned in favour of mobilized blood stem-cell transplantation, laboratory investigation of non-mobilized circulating stem cells will be needed if a full understanding of their purpose and function is to be learned.

Blood Component Removal↗

PubMedDate not supplied

Use of DTIC in the malignant carcinoid syndrome.

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Dacarbazine↗