Poor graft function can be durably and safely improved by CD34+-selected stem cell boosts after allogeneic unrelated matched or mismatched hematopoietic cell transplantation.

Abstract

PURPOSE:

Insufficient production of leukocytes, thrombocytes and erythrocytes after allogeneic peripheral blood stem cell transplantation (PBSCT) represents a life-threatening complication.

METHODS:

In 20 adult patients with poor graft function (PGF defined as transfusion-dependent platelet counts <20,000/µl, or leukocytes <1500/µl, or transfusion-dependent anemia) and variable causes of PGF after allogeneic PBSCT, immunomagnetically selected CD34(+) stem cell boosts (SCB) from matched unrelated (n = 8), mismatched unrelated (n = 11) or haploidentical (n = 1) donors were applied without prior conditioning.

RESULTS:

Patients received a median of 4.6 × 10(6) CD34(+) cells per kilogram bodyweight (1.9-9.1 × 10(6)) and low T cell numbers (median 0.2 × 10(4), range 0.04-0.6 × 10(4)). All patients showed responses in at least one hematopoietic lineage. Engraftment for platelets, leukocytes and hemoglobin was 88, 88 and 100 % after a median of 14, 13 and 18 days, respectively. With regard to the complete cohort, 90 % (n = 18) showed an increase in platelets (median 76,500/µl, range -7000 to 223,000/µl), 95 % (n = 19) had an increase in leukocytes (median 3110/µl, range 150-13,740/µl) and 90 % (n = 18) improved with regard to hemoglobin (median 1.9 g/dl, range -0.9 to 5.1 g/dl). Due to effective T cell depletion, only one patient developed graft versus host disease (GvHD, grade III) after SCB. Patients were followed for a median of 7.5 months (1-74 months) with 11 patients being alive and disease free with normalized peripheral blood counts at the end of follow-up.

CONCLUSIONS:

CD34(+)-selected SCB are safe and effective and can durably improve PGF even in patients receiving grafts from unrelated matched or mismatched donors with low incidence of GvHD.

• Authors: Sebastian P Haen, Michael Schumm, Christoph Faul, Lothar Kanz, Wolfgang A Bethge, Wichard Vogel
• Journal: Journal of cancer research and clinical oncology (J Cancer Res Clin Oncol) Vol. 141 Issue 12 Pg. 2241-51 (Dec 2015) ISSN: 1432-1335 [Electronic] Germany
• PMID: 26272482 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, CD34

Topics

• Adult
• Antigens, CD34 (immunology)
• Cohort Studies
• Female
• Follow-Up Studies
• Graft Survival
• Graft vs Host Disease (etiology, mortality, prevention & control)
• Hematologic Neoplasms (complications, therapy)
• Histocompatibility
• Humans
• Leukapheresis
• Male
• Middle Aged
• Peripheral Blood Stem Cell Transplantation (adverse effects)
• Prognosis
• Stem Cells (cytology, immunology)
• Survival Rate
• Tissue Donors
• Transplantation Conditioning
• Transplantation, Homologous
• Unrelated Donors
• Young Adult