Plastic-Adherent Progenitor Cells in Mobilized
Transcription
Plastic-Adherent Progenitor Cells in Mobilized
From www.bloodjournal.org by guest on January 21, 2015. For personal use only. Plastic-Adherent Progenitor Cells in Mobilized Peripheral Blood Progenitor Cell Collections By M.A. Scott, J.F. Apperley, H.K. Jestice, D.M. Bloxham, R.E. Marcus, and M.Y. Gordon The useof peripheral blood progenitorcells (PBPC) t o reconstitute hematopoiesis after high-dosechemoradiotherapy is now commonplace in the treatment of malignancies. Attempts t o characterize these cells have concentrated primarily on their phenotype and their content of clonogenic colony-forming cells (CFC).We have used a plastic-adherent delta (PA) assay system t o evaluate the quantity and quality of more primitivecells in addition to theconventional measurements ofCFC and CD34-positive cells. Theleukapheresis products from 20 patients mobilized using cyclophosphamide (Cy) and granulocyte colony-stimulating factor (G-CSF) were examined for progenitor cell content. The mean number of mononuclear cells (MNC), colony-forming units-granulocyte/macrophage (CFU-GM), and CD34-positive cells from twoleukaphereses per patient were 7.9 x 108/kg, 47.3 x lO'/kg, and 10.5 x 106/kg, respectively. The mean number of P A progenitors was 9.3 x 104/kg. Limiting dilutionanalyses showed thefrequency of P A progenitors in PBPC t o be between 1 and 5.3 per I O 5 MNC and thateach P A progenitor has the proliferative capability t o generate an overall mean of 4.5 CFU-GM. Of the 20 patients, 16 underwent autografting with PBPC alone. Fifteen patients engrafted neutrophils and platelets within 16 days. One patient had delayed engraftment associated with inadequate etoposide clearance. Statistical analysis showed a strong correlation between numbers of CFU-GM and CD34 positivity. The numbers of plastic-adherent P A progenitor cells did not correlate with CFU-GM or CD34-positive cells. We conclude that theplasticadherent P A progenitor cell assay is capable of measuring primitive hematopoietic cells and that it may be useful for the investigation of primitive progenitors in PBPC harvests. 0 7995 by The American Society of Hematology. P cell counts could be due tothe reinfusion o f a large spectrum of differentiating progenitors in the leukapheresis product. However, little is known of the characteristics and kinetics of the cells with long-term repopulating ability that are harvested using this procedure. After cyclophosphamide treatment, with or without GM-CSF, the numbers of circulating CD34-positivecellsandcolony-formingcells(CFC) decrease toundetectable levels, and their reappearance together with theappearance of long-termculture-initiating cells (LTC-IC) parallels white blood cell (WBC) recovery.13 I' We have examined cellscollected by apheresis after mobilization with cyclophosphamide and G-CSFto assess their progenitor content using a recently devised assay for plastic-adherent (PA) progenitor cells,Is in addition to the traditional colonyforming unit-granulocyte/macrophage (CFU-GM) assay and quantitation of CD34-positive cells. The fraction of bone marrow mononuclear cells that adheres to plastic contains progenitors capable of generating substantialnumbers of CFU-GM in a l-week-longdelta assay system. The plastic-adherent progenitors have, therefore, been called PA progenitors. Their early position in the hematopoietic hierarchy has been confirmed by their ability to generate long-term in vitro hematopoiesis, burst-forming units-erythroid (BFU-E), andcobblestone area-forming cells (CAFC)'" in addition toCFU-GM; theirresistance to 5fluorouracil''; their coexpression of the early phenotypic antigens CD34 and Thy- 1 "; and the absence of expression of HLA-DR,CD33,andCD38.IX Removal of adherent cells from murine marrow compromises its ability to reconstitute irradiated recipients,"~" suggesting that adherence depletes repopulatingcells. This studyhasassessedthefrequency and proliferative potential of P A progenitors in mobilized PBPC collections and compared them with CFU-GM and CD34-positive cells as markers of progenitor cell content and engraftment kinetics. ERIPHERAL BLOOD progenitor cells (PBPC) mobilized by chemotherapy, with or without hematopoietic growth factors (HGFs), are beingused increasingly to reconstitute hematopoiesis after high-dose chemoradiotherapy for avarietyofhematologic and other malignancies."' It has beenknown for some time that primitive progenitor cells circulate in low numbers in steady-state peripheral and their numbers increase dramatically after various treatm e n k c In mice, the numbers of repopulating stem cells have been shown to increase during the recovery phase after chemotherapy,' and after the administration of an HGF such as granulocyte colony-stimulating factor (G-CSF). In humans, G-CSF"'" and granulocyte-macrophage (GM)-CSF" are the most widely used cytokines in mobilization protocols. The major advantage of PBPC transplantation over conventional autologousbone marrowtransplantation (ABMT) isthe more rapid recoveryof peripheral blood neutrophil and plateof pancytopenia let counts, therebyshorteningtheperiod thatis responsibleforthe life-threateninginfections and hemorrhage associated with transplantation. A reduction in a therequirement for antibiotics and bloodproductsand shorterhospitalstay can result in an overall costsaving as compared with ABMT," although the financial benefits remain somewhat controversial. It is believed that the rapid recovery of peripheral blood From the Department of Haematology, Addenbrooke's NHS Trust, Cambridge; and the Department of Haematology, Royal Postgraduate Medical School, Lnndon, UK. Submitted November 29, 1994; accepted July 31, 1995. Supported by The Leukaemia Research Fund of Great Britain and The Kay Kendall Leukaemia Fund. Address reprint requests to M.A. Scott, Bone Marrow Transplant Unit, Department of Haematology, Addenbrooke's NHS Trust, Hills Road, Cambridge CB2 2QQ. UK. The publication costs of this article were defrayedin part by page chargepayment.Thisarticle must thereforebeherebymarked "advertisement" in accordance with 18 U.S.C. section 1734 solely to indicate this fact. 0 1995 by The American Society of Hematology. 0006-4971/95/8612-0023$3.00/0 4468 MATERIALS AND METHODS Patients and PBPC collection. Twenty consecutive patients underwent PBPC collection and subsequent autografting in Cambridge, UK, between April and August 1994. All gave informed consent. Diagnoses included non-Hodgkin's lymphoma (NHL; I I patients), Blood, Vol 86, No 12 (December 15). 1995: pp 4468-4473 From www.bloodjournal.org by guest on January 21, 2015. For personal use only. CELLS PLASTIC-ADHERENT IN PBPC COLLECTIONS 4469 Table 1. Patient Details and Progenitor Cell Yields Engraftment No. of CelldProgenitors Harvested UPN 21 1 225 230 235 240 244 2 46 ~i~~~~~ MM MM MM MM MM ” AB MM MM 207 213 219 221 222 223 226 228 242 243 245 239 NHL NHL NHL NHL NHL NHL NHL NHL NHL NHL NHL HD MNC X 108/kg 6.3 13.2 16.4 17.7 3.0 16.0 8.5 8.1 5.8 4.2 9.3 4.2 7.3 5.6 5.6 5.3 9.0 5.9 6.9 6.5 CFU-GM X 10‘/kg 48.0 95.5 140.5 31.5 17.1 193.6 1.8 40.2 13.7 5.1 31.1 47.9 18.7 24.6 11.3 12.0 74.1 12.2 38.2 16.2 CD34+ Cells x 1O6/kg n/a 24.9 13.1 14.2 3.8 44.6 NA 10.2 NA NA 12.6 6.4 2.8 2.1 3.2 4.8 9.8 2.9 5.7 5.5 PA Cells x 104kg Count 10.4 2.7 36.8 7.3 12.6 23.5 0.5 9.0 28.6 0.9 5.0 5.8 3.9 6.1 3.5 4.9 5.8 7.3 7.7 4.1 Days t o Neutrophil > 0.5 x 1 o V ~ Days t o Platelet Count > 50 x 10% 12 12 25 10 9 45 - - 11 10 12 9 - - - - 10 11 - - 12 11 13 14 13 11 12 11 14 14 10 16 13 13 14 15 16 14 13 12 Reinfusion doses given as per kilogram body weight. Engraftment data were excluded from patients 213 and 246 who received autologous bone marrow in addition to PBPC, patient 235 who received CD34-purifiedcells, and patient AB who did not undergo autografting and was not assigned a UPN. There were no statistical differences between the numbers of progenitor cells collected from the patients with myeloma and the patients with lymphoma (CFU-GM,P = .49; CD34, P = .49; PA, P = .47). Abbreviations: MM, multiple myeloma; NA, results not available. Hodgkin’s disease (HD; one patient), and multiple myeloma (eight patients). Patient characteristics are listed in Table 1. The patients with lymphoma were a heavily pretreated cohort, while themyeloma group had received induction chemotherapy with vincristine, Adriamycin, and dexamethasone (VAD) but no other chemotherapy. All patients were primed with cyclophosphamide (Cy; Farmitalia Carlo Erba Ltd. St Albans, UK) 3 g/m2 and G-CSF (Amgen Ltd, Cambridge, UK) 5 pg/kg/d to mobilize their PBPC. Cells were harvested on 2 consecutive days when the recovering WBC count surpassed 4 X 1Oy/L. Usinga Cobe Spectra continuous flow apheresis machine, three times the patient’s estimated blood volume was processed via a double lumen central line of dialysis quality (Quinton Mahurker, Seattle, WA) using the manufacturer’s WBC set (Cobe 777 006 000). The procedure took between 3 and 4 hours and used ananticoagulant-to-blood ratio of 1: 14. Flow rates varied between 60 and 80 mL/min, and a separation factor of 900 was used. Throughout the collection, the hematocrit of the harvested cells was maintained between 2%and 4%, and the resultant mononuclear cell volume ranged from 140 to 180 mL. Red cell contamination was less than 5% in all cases. The cells were frozen in a rate-controlled freezer and stored in the vapor phase of liquid nitrogen. The cryopreserved-thawed cells were reinfused after conditioning therapy using the BEM regimen.” Briefly, this consists of BCNU 300 or 450 mg/m2 (according to lung function tests), etoposide 2 g/m’. and melphalan 140 mg/m’.No hematopoietic growth factors were administered after the autograft. Venous blood was taken from 10 laboratory volunteers as controls. CFU-CM assay. Mononuclear cells (MNC) from each leukapheresis were isolated by density-gradient separation over Histopaque-1.077 (Sigma Diagnostics, Poole, UK). The cells from the interface were harvested and washed twice in Hank’s buffered salt solution (HBSS; GIBCO, Paisley, UK). They were resuspended in 1 mLof HBSSand counted. Fresh viable MNC were plated in duplicate in 35-mm Petri dishes (Nunc, Life Technologies, Ltd, Paisley, UK)in semisolid medium containing 1.0% methylcellulose (Fluka, Buchs, Switzerland) in Iscove’s modified Dulbecco’s medium (GIBCO) 30% fetal calf serum (FCS; GIBCO), 1 % bovine serum albumin (Sigma Diagnostics), P-mercaptoethanol ( 5 X m o m ; Sigma Diagnostics), and recombinant GM-CSF (50 IU/mL; Schering-Plough, Mildenhall, UK) asa source of hematopoietic growth factor. The MNC were incubated at 37°C in humidified 5% CO, in air for 14 days. Colonies of more than 50 cells were scored on day 14. Results were expressed as the number of CFU-GM per 10’ MNC plated and converted to a reinfusion dose per kilogram of body weight. Deltaassay of plastic-adherent (PA) progenitorcells. MNC from the PBPC collections were isolated by density-gradient separation. Ten million MNC were suspended in 10 mL a-medium (GIBCO) supplemented with 15% fetal calf serum and incubated at 37°C in humidified 5% CO2 in air for 2 hours in 25-cm plastic tissue culture flasks (Nunc). Preliminary experiments showed that increasing the incubation period to 18hours did not increase the number of progenitor cells that adhered to the flask (unpublished data). Nonadherent cells were removed by washing the flasks three times with HBSS. Next, a-medium supplemented with 10% FCS, 10%horseserum (GIBCO), 10% 5637 conditionedmedium,”and 2 X IO-‘ m o m methylprednisolone (Upjohn, Crawley, UK) was added to the flasks containing the residual adherent cells. The flasks were incubated at 37°C in humidified 5% CO2 in air for 7 days. The nonadherent cells were harvested and assayed for CFU-GM. Colonies of more than 50 cells were scored on day 7; of more than 200 cells, on day 14; and of more than 500 cells, on day 21.” Colonies were expressed as the number of CFU-GM per flask per lo7 cells plated and backcalculated to give the number of PA progenitor cells present per milliliter of blood; and hence, the numbers reinfused. From www.bloodjournal.org by guest on January 21, 2015. For personal use only. 4470 SCOTT ET AL 200 - 175 - 150 - Limiting dilution analysis. Limiting dilution analysis wasused to establish the frequency and proliferative potential of the PA progenitors in the PBPC collections. The assays were performed in 96well plates (Nunc) using 100-pL volumes in a scaled down version of the bulk cultures in flasks. In five experiments, five mononuclear cell concentrations (lo5,3 X IO4, IO4, 3 X IO3, and IO’) were added to at least 32 replicate wells per group. The frequency of the PA progenitors was calculated according to TaswelL2’ The number of CFU-GM produced per individual PA progenitor cell was evaluated from wells with a probability of monoclonality of more than 75%. In one experiment, 96 replicate wells wereusedto confirm the distribution obtained from the other experiments. CD34-positive enumeration. Unpurified PBPC were incubated for 15 minutes with directly conjugated monoclonal antibodies CD45-fluorescein isothiocyanate (FITC; HLe-l clone; Becton Dickinson, Cowley, UK) and CD34-phycoerythrin (PE; HPCA-2 clone; Becton Dickinson). Red cells were lysed using Facslyse (Becton Dickinson). Twenty thousand CD45-positive events were analyzed for CD34-PE positivity using a Coulter EPICS Elite flow cytometer (Coulter Electronics, Luton, UK). Only those cells clustering with low side scatter properties were included in the analysis. The results were expressed as the percentage of the total leukocytes collected and converted to the absolute number of CD34-positive cells per collection. Statistical analysis. All statistical analyses were performed using a computer statistical package (Statview; Abacus Software, Berkeley, CA). Simple linear regression analysis was used to examine potential correlations. Statistical significance was assessed using the Mann Whitney U test, Wilcoxon signed rank test, and the Kruskal-Wallis test for multiple samples. respectively. The numbers of MNC and progenitors harvested are listed in Table 1. There was a significant correlation(Fig 1) between the numbers of CFU-GM and CD34-positive cells ( r = 36: P = .001), but thenumbers of plastic-adherent PA progenitor cells did not correlate with CFU-GM or CD34-positive cells. Quuntitution of PA progenitors. We first examined PA cultures from the peripheral blood of 10 normal volunteers. Four of the I O volunteers produced less than one CFU-GM per flask per 10’ mononuclear cells plated. The remainder producedbetween 10 and SO CFU-GM. A single limiting dilution experiment on normal blood gave a frequency of l / 10” mononuclear cells. Four limiting dilution analyses of PBPC gave frequencies of PA progenitor cells of between I 2 0.3 (mean i- SE: 95% range, 0.3 to 1.6) and 5.3 t 0.7 (3.8 to 6.7) per IO’ MNC, which is similar to that of normal bone marrow (2.5 to 10 per IO’ MNC).” The fifth analysis gave a frequency of 0.3/10h, whichis similar tonormal blood, and because only 3%of thewellswere positive, this analysis was excluded from further calculations. The proliferative potential of individual PA progenitors was heterogeneous with respect to CFU-GM production within experiments, but the distributions for different samples were very similar ( P = 3 , Kruskal-Wallis Test; Fig 2). Consequently, it seemed justified to calculate the number of PA progenitor cells present in the bulk cultures by dividing the total number of CFU-GM produced by the mean of the individual values (2.4, 3.4, 5.1, and 7.1) for CFU-GM per PA progenitor cell (ie, 4.5 i 1.8). The derived number of PA cells infused is listed in Table 1. Engraftment kinetics. Of the 20 patients who underwent PBPC mobilization and collection, four were excluded from further evaluation. The cells from one patient (unique patient number [UPN] 235) were further manipulated to obtain purified CD34-positive cells, two patients (UPN 213 and 246) yielded low numbersof CFU-GM and subsequently received stored back-up autologous bone marrow together with their PBPC, and one patient (AB) relapsed and did not undergo autografting. All patients who received PBPC alone were given more than our threshold number of 10 X l O4 CFU-GM24and more than 2.7 X 1O4 PA cells per kilogram. Fifteen of 16 patients engrafted rapidly, with a median of 12 days to a neutrophil count of greater than 0.5 X I O ’ L and 12 days to a sustained platelet count of greater than 50 X 10’L. The remaining patient (UPN 230)had delayed engraftment (25 and 45 days), whichwas associated withpoorrenal clearance of etoposide. Infusion of more than the threshold number of cells and consistent rapid engraftment precluded evaluation of an association between progenitor cell numbers and engraftment kinetics. RESULTS DISCUSSION 0 M 3 125- %i 100- 2 75- 2 5: [? V 50 - CD34-positive cellsx lo6per kg Fig 1. Correlation between the numbers of CFU-GM and CD34positive cells in the leukapheresis harvests (n = 16). PBPC harvesting. The median time taken for the recovering WBC count to reach 4 X 109Lwas 10 days (range, 9 to 13 days). The mean number of MNC collected from two leukaphereses was 7.9 X 108/kg, of which 10.5 X 106/kg were CD34-positive. Mean numbers of day-l4 CFU-GM and PA progenitors were 47.3 X 104/kg and 9.3 X 104/kg, Small numbers of primitive hematopoietic progenitor cells are known to circulate in steady-state peripheral b l ~ o d .In ~.~ the recovery phase after chemotherapy or after administration of certain HGFs, numbers increase to levels that allow collection and subsequent autografting. For reasons that are not entirely clear, engraftment after PBPC transplantation is From www.bloodjournal.org by guest on January 21, 2015. For personal use only. 441 1 PLASTIC-ADHERENTCELLS IN PBPCCOLLECTIONS Day 14 Day 7 100 l " 19 0 5 U Fig 2. Cumulative distribution of CFU-GM numbers (days 7,14, and 21 and total) produced by individual P A progenitors cultured at limitingdilution. The data plotted were taken from the cell concentration that corresponded to a probability of greater than .75 that the contents of the wells were monoclonal. Theresults are from three separate experiments. They axis shows the percentage of positive wells yielding between 1 and n CFU-GM; results from the negative wells are not plotted. The individual curves represent results from 7 to 12 wells. The frequenciesofnegative wells were 0.63, 0.75, and 0.78; the probabilities of monoclonali were SO, .75, and .78. In one experiment (data not plotted)consisting of 96 replicate wells, 11.5% of the wells were positive (probability of monoclonality = .94) and produced a total of 1 to 11 CFU-GM. 10 15 0 20 5 10 15 20 n CFW-GMper well CFUGM pet well Day 2I Total 2B 2e, *B 0 5 10 15 n Cm-GM per well more rapid than with bone marrow, presumably as a result of infusing a spectrum of differentiating cells. This procedure has radically altered the clinical approach to high-dose therapy and stem cell rescue. The kinetics and characteristics of PBPC are under intensive investigation and are as yet not fully understood. Much of this work has focused on CD34positive cells and CFU-GM, but the long-term culture system, which requires bone marrow stroma as a feeder layer, has been used to study more primitive progenitor cells.I4 A recently described assay takes advantage of the adherent nature of primitive hematopoietic cells in bone When cultured in a plastic tissue culture flask, the nonadherent component that contains CFU-GM is removed, leaving earlier progenitors adherent to the side of the flask. Subsequent CFU-GM production can, therefore, be attributed to the pre-CFU-GM that adhered to the flask. It is possible to 20 n CFU-GMper well measure C m - G M after 7 days because preexisting CFUGM are removed at the outset and because stromal cells, which inhibit CFU-GM prod~ction?~ are not present to any significant degree in the first 7 days of culture. We have used this assay to measure the frequency and proliferative capacity of these cells in PBPC collections. Limiting dilution analysis has shown that the frequency of PA progenitor cells in PBPC collections is similar to that of normalbonemarrow (ie, 1 to 5.3 v 2.5 to 10 per IO5 MNC, re~pectively),'~ but their capacity to generate CFUGM is markedly less. Comparison of the distribution of the numbers of CFU-GM produced by PA cells in PBPC with the distribution of the numbers produced by PA cells in normal bone marrowL5reveals a significant difference (P = .001, Wilcoxon signed rank test). The overall mean value of 4.5 2 1.8 CFU-GM per PA progenitor cell that we have From www.bloodjournal.org by guest on January 21, 2015. For personal use only. 4472 measured for PBPC can be compared with a mean value for normal marrow (n = 9) of 24 t 14 (Gordon" and unpublished data, 1995; P = ,005, Mann-Whitney U test). This could reflect thepresence of moremature PA progenitor cells in the PBPC harvests compared with bonemarrow, which may only be capable of a small number of divisions before terminaldifferentiation.Alternatively,the PA cells from PBPCmay undergo undetectable self-renewaldivisions resulting in lower outputof CFU-GM in the short timeperiod used for the assay. Insupport of this suggestion, the cumulative distribution of CFU-GM production (Fig 2) is similar to that for PA cells in human umbilical cord blood (HUCB), whichhavebeenshown tobecapable of self-renewal.'" Sutherland et all4 have reported a similar phenomenon with regard to LTC-IC in PBPC collections, which produce fewer CFU-GM than LTC-IC in normal bone marrow. The heterogeneity of CFU-GM production by individual progenitor cells is a common feature of several hematopoietic cell assay system~.''.~'.~'Oneexplanation isthatthe heterogeneous progenitor cell population represents a spectrum of cells with different degrees of maturity and ability to generate more mature progeny. Another is that cells undergo self-renewal or differentiation according to a stochastic distribution of probability. It is tempting to speculatethat the probability of P A progenitor cell self-renewal in PBPC and HUCB is greater thanthat of P A cells in adult bone marrow. This would imply that PBPC collected after mobilization therapy contain a population of cells that are more capable of amplification than those found in a bone marrow harvest. It is relevant in this context that PBPC have been identifiedasidealtargets for retroviralgene transfer." It may be thattheseprimitiveprogenitor cells are normally held in microenvironmental niches and are not released during bone marrow sampling.However,chemotherapyand growth factor administration may alter expression of adhesion proteins and result in the detachmentof these cells from the stromal compartment. Although CFU-GM production by individual P A cells in PBPC is heterogeneous, the range of clonogenic production is fairly narrow withineach experiment, and the distributions obtained from theindividual experiments were indistinguishable statistically. It was, therefore, reasonableto use the overall mean of 4.5 CFU-GM per individual precursor cell, obtained from four limiting dilution experiments, to estimate the number of PA progenitor cells inbulkcultures. The number of CFU-GM per PA cell is slightly higher than the I .6 seen with LTC-IC." Of the 16 patients whounderwent autografting with PBPC alone, 15 engraftedneutrophils and plateletsrapidlywith no subsequent transient decrease in counts. There was no statistical difference between engraftment times and parameters associated with progenitor cells. Only one patient (UPN 230) haddelayed engraftmentdespite receiving adequate numbers of CFU-GM (140.5 X 104/kg). This was believed to be due to inadequate clearanceof etoposide as a result of deranged renal function associated with renal amyloidosis. We found no correlation between numbers of primitive P A cells in our assay system and the number of CFU-GM orCD34-positivecells presentin the harvests.Similarly, SCOTT ET AL Sutherland et all' did not find a correlation between LTCIC and CFU-GM or CD34-positive cells. This is not unexpected, as these two primitive populations are much smaller fractions of the total CD34-positive population than are CFU-GM. Results from individual patients in thestudy showed that PA progenitors are present in PBPC collections to varying degrees. In the twopatients who had low numbers of CFU-GM (our target value is 10 X I O'/kg), PA cells were 0.5 X IO'//lig and 0.9 X 1O4/kg.The lowest number of PA cells measured in a patient who engrafted successfully was 2.7 X lO''/kg. It may be that the minimum required number lies between 0.9 X IO'Ikg and 2.7 X IOJ/kg. However, this is difficult to demonstrate,as the majority of patients recover their counts within 16 days. Although there is no correlation evident between P A cells and engraftment, or between LTCIC andengraftment, there may be a thresholdeffect for primitive cells similar to that for the numbers of CFU-GM infused.*4 Weconclude thattheplastic-adherentprogenitor cell assay is capable of measuring the quality and quantity of primitive cells that are ancestral to CFU-GM in the hematopoietic hierarchy. ACKNOWLEDGMENT We are grateful to Dr N.M. Blackett for assistance with statistics. REFERENCES 1.BriceP,Marolleau JP, Dombret H, Lepage E, Baruchel A. Adam M, Miclea JM, Sitthy X, Gisselbrecht C: Autologous peripheral blood stem cell transplantation after high dose therapy in patients with advanced lymphomas. Bone Marrow Transplant 9:337, 1992 2. Reiffers J, Marit G, Boiron JM, Rice A, Bernard P, Vezon G: The role of peripheral blood stem cells as rescue after myeloablative therapy. Bone Marrow Transplant 1:212. 1989 JM, DeChristopherPJ. 3.Williams SF, BitranJD,Richards BarkerE,Conant J, GolombHM,Orlina AR: Peripheral bloodderived stem cell collections for use in autologous transplantation after high dose chemotherapy: An alternative approach. Bone Marrow Transplant 5: 129, 1990 4. GoodmanJW,Hodgson CS: Evidence for stem cells in the peripheral blood of mice. Blood 19:702, 1962 5. McCredie KB, Hersh EM, Freireich EJ:Cells capableof colony formation in the peripheral blood of man. Science 171:293. 197 I 6 . 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For personal use only. 1995 86: 4468-4473 Plastic-adherent progenitor cells in mobilized peripheral blood progenitor cell collections MA Scott, JF Apperley, HK Jestice, DM Bloxham, RE Marcus and MY Gordon Updated information and services can be found at: http://www.bloodjournal.org/content/86/12/4468.full.html Articles on similar topics can be found in the following Blood collections Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. 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